Charged with Healthcare Fraud in Wisconsin? You Need a Lawyer

 Posted on January 13, 2025 in White Collar Crimes

If you are a healthcare provider, a charge of healthcare fraud can have serious implications. Not only do you face potential criminal penalties such as jail time and fines, but the accusation can threaten your livelihood and reputation. If convicted of healthcare fraud, you could be excluded from participating in federal healthcare programs and even lose your license to practice medicine. These are serious charges that require the help of an experienced Milwaukee, WI attorney ready to defend you.

What Is Healthcare Fraud?

Healthcare fraud involves intentionally misrepresenting or providing deceptive information about medical claims. Usually, a healthcare fraud allegation accuses a doctor, clinic, or other healthcare provider of charging for services that were not provided or medically necessary in order to pocket the money.

Other examples of healthcare fraud include:

• Making false claims for medical procedures

• Defrauding a medical program such as Medicare or Medicaid

• Billing for services that were not provided 

• Falsifying certificates that state something is medically necessary in order to bill

• Soliciting illegal referrals or kickbacks to provide goods or services

• Unlawfully prescribing medication

• Falsifying treatment plans for billing purposes

• Unbundling and upcoding

What Laws Penalize Healthcare Fraud?

There is no one healthcare fraud law. Several federal and state laws impose criminal penalties for healthcare fraud, and you can be charged under one or a combination of these laws if the government believes you have perpetrated healthcare fraud, including:

• Health Care Fraud Statute

• False Claims Act

• Physician Self-Referral Law

• Criminal Health Care Fraud Statute

• Anti-Kickback Statute

• Patient Access and Medicare Protection Act

• Wisconsin Medical Assistance Fraud Statute

How Can Compliance Help My Healthcare Fraud Charges?

The best offense is a good defense. Similarly, when it comes to healthcare fraud, the first line of defense is compliance to ensure that your organization is following the rules and to encourage a culture of transparency. By regularly training your organization’s staff and communicating clear policies, you can protect against violations.

The government also tends to look favorably on compliance programs when evaluating healthcare fraud allegations. In addition, if despite strong compliance you or your organization are accused of healthcare fraud, having in place a compliance program that regularly conducts audits of billing practices and documents can make it easier for you to collect evidence for your defense.

How Can You Defend Against Healthcare Fraud Charges?

The first thing to do when defending healthcare fraud allegations is to understand what the charges are and how they apply to the facts of your case. For example, if you are accused of falsifying billing, did your office make accidental billing mistakes? Alternatively, are the charges against you the result of a whistleblower complaint? Many healthcare fraud charges stem from the complaints of former (and perhaps disgruntled) employees.

Next, your attorney will consider which defenses to use to battle the healthcare fraud charges: 

No Intent

The prosecution must generally prove that you intended to commit the fraud. Most healthcare fraud cases involve allegations that you knowingly attempted to defraud a healthcare program. If you take away your intent to deceive or misrepresent, you take away your liability.

Mistaken Identity

Mistaken identity errors are more common than you would think. If you can prove that the charges are a case of mistaken identity, that can be a strong defense.

Not Enough Evidence

Weak evidence will make it difficult to convict you of healthcare fraud. Your attorney will challenge the strength of the prosecution’s evidence, including the credibility of witnesses such as disgruntled employees and jealous competitors. Your strong expert witnesses can also challenge the prosecution’s interpretation of the evidence.

Coercion or Duress

If you were coerced into committing healthcare fraud, you can claim this as a defense.

No Knowledge 

Honest mistakes and errors in billing and coding happen. A legitimate administrative error can be used as a defense to a healthcare fraud charge.

Good Faith

If you had a strong compliance program in place, this can help show that you acted in good faith. Likewise, evidence that you acted based on solid legal and professional advice about billing practices can strengthen your case.

How Can a Lawyer Defend You Against Healthcare Fraud Charges?

Healthcare fraud charges should be taken seriously. By hiring an attorney with specific experience defending healthcare fraud charges you can understand your rights and be ready to mount a strong defense. You need a healthcare fraud defense attorney for several reasons:

• They can set up a compliance program: Implementing policies against healthcare fraud and educating your organization on the legal way to run a medical business can stop healthcare fraud before it starts.

• They have experience defending healthcare fraud: A lawyer with specific experience understands the way to defend against charges under several federal and state statutes.

• They will begin evaluating your case and gathering evidence right away: By hiring an attorney right away, you have time to gather crucial evidence, including conducting an internal investigation and compiling witness testimony.

• They will know how and when to negotiate a settlement: A healthcare fraud attorney will not only be ready to defend you in court but have experience negotiating a deal with the prosecution to minimize penalties and reputational damage. This is especially important because your livelihood and career are at stake, and an attorney will work to protect those as well.  

• They will advise you on civil liability and exclusions: Additional civil healthcare fraud laws impose civil penalties and exclusion from federal medical programs for perpetrators of healthcare fraud. An attorney will take this into account when they develop your defense strategy.  

• They will tell you where you stand: By hiring an experienced lawyer, you can get clear information about what the charges against you mean and what are your chances of success.

Contact Our Wisconsin Healthcare Fraud Defense Attorneys

If you have been charged with healthcare fraud, the experienced Milwaukee, WI healthcare fraud defense attorneys at Gimbel, Reilly, Guerin & Brown, LLP can mount a strong legal defense to protect you from criminal penalties and to protect your livelihood. Contact our offices by calling 414-271-1440 and set up a consultation to discuss the most effective strategy to respond to these serious accusations.