In recent years, the Centers for Medicare and Medicaid Services (CMS), the Department of Defense (DOD), the Department of Justice (DOJ) and other federal agencies have intensified their efforts to combat healthcare fraud. Healthcare is a multi-trillion-dollar industry, with a significant portion of that money coming from Medicare, Medicaid, Tricare and other federal government programs.
The federal government’s efforts to combat healthcare fraud range from establishing an elite task force comprised of top agents and prosecutors (the Health Care Fraud Prevention and Enforcement Action Team, or “HEAT”) to using big data to identify anomalies that may be indicative of fraud. Unfortunately, while this reliance on data has saved the federal government billions, it has forced numerous innocent healthcare providers to defend themselves in unwarranted investigations as well.
What Constitutes Healthcare Fraud?
“Healthcare fraud” is a broad term that encompasses a wide range of offenses under a number of different federal laws. Three of the most common forms of healthcare fraud include:
- Anti–Kickback Violations – The Stark Law and other federal laws prohibit physicians and other healthcare providers from receiving referral fees, rebates and other “kickbacks” under a variety of circumstances.
- Billing Fraud – This involves submitting false or fraudulent reimbursement requests to Medicare, Medicaid, Tricare and other benefit programs. Some common examples include things like billing for services that were never provided (phantom billing) and double-billing.
- False Claims Act Violations – Both the federal government and private citizens can initiate litigation under the False Claims Act. Billing fraud and anti-kickback violations are both common examples of False Claims Act violations, as are unbundling services in order to claim higher reimbursement rates and submitting fraudulent physician certifications.
Healthcare fraud can be charged as both a civil and a criminal offense. A finding of civil liability can mean thousands, if not hundreds of thousands or millions of dollars in fines and penalties, while a criminal conviction for healthcare fraud can potentially mean decades of federal incarceration.
When Should You Hire a Healthcare Fraud Defense Attorney?
If you or your business is facing a federal investigation for healthcare fraud in the Raleigh area, it is critical that you speak with a federal criminal defense attorney as soon as possible. You are entitled to legal representation during the government’s investigation, and hiring a lawyer before you get charged can have numerous benefits.
At the top of the list, if the government will not drop the investigation, your attorney will be able to argue that your case should remain civil in nature. Keeping your case civil reduces your potential exposure, and it keeps prison time off of the table.
Learn more about the benefits of hiring a lawyer during your federal healthcare fraud investigation.
Schedule a Confidential Initial Consultation at Cheshire Parker Schneider & Bryan, PLLC
The Raleigh, NC criminal defense attorneys at Cheshire Parker Schneider & Bryan, PLLC have decades of experience representing clients in healthcare and other federal investigations. If you have been contacted by federal agents, received a subpoena or suspect that you may be the target of a federal investigation, call (919) 833-3114 or contact us online to schedule a consultation today.
As a licensed professional in North Carolina, facing criminal charges can cause significant harm to your reputation, especially if the charges become publicized. But, did you know that, in many instances, facing criminal charges can put your professional license at risk as well?
In many professions requiring licensure, commission of a criminal act is grounds for license suspension or revocation. While the rules governing some professions only provide for discipline in the event that a professional commits a crime that is in some way relevant to his or her practice, these rules are often subject to broad interpretation. As a result, if you are a licensed professional facing criminal charges in North Carolina, you may need to defend yourself on two separate fronts in order to attempt to safeguard your career.
When Criminal Charges May Lead to Professional Discipline
The following are a few, non-exclusive examples of licensing laws and rules in North Carolina that provide for potential discipline when a professional faces criminal charges:
1. North Carolina Rules of Professional Conduct for Lawyers
Under Rule 8.4 (“Misconduct”) of the Rules of Professional Conduct, it is professional misconduct for a lawyer to, “commit a criminal act that reflects adversely on the lawyer’s honesty, trustworthiness or fitness as a lawyer in other respects.”
Under Comment  to Rule 8.4, “[o]ffenses involving violence, dishonesty, breach of trust, or serious interference with the administration of justice,” may all warrant disciplinary action. Comment  makes clear that a conviction is not necessary to establish that a lawyer has committed a criminal act.
2. North Carolina General Statutes Chapter 90, Medicine and Allied Occupations
Under Section 90-14(a) of the North Carolina General Statutes, the North Carolina Medical Board (the “Board”) has the authority to revoke a physician’s license if he or she is convicted, “in any court of a crime involving moral turpitude, or the violation of a law involving the practice of medicine, or a conviction of a felony.”
Pursuant to subsection (c) of Section 90-14, a felony conviction results in automatic revocation of the physician’s license unless (i) the Board decides otherwise, or (ii) the physician submits a request for a hearing within 60 days of receiving notice from the Board.
3. North Carolina General Statutes Chapter 93, Real Estate License Law
Under Section 93A-6(b) of the North Carolina General Statutes, the North Carolina Real Estate Commission has the power to suspect or revoke the license of any licensee who, “has been convicted or has entered a plea of guilty or no contest . . . of any misdemeanor or felony that involves false swearing, misrepresentation, deceit, extortion, theft . . . or any other offense showing professional unfitness or involving moral turpitude.” In addition, to justify suspension or revocation, the offense must, “reasonably affect the licensee’s performance in the real estate business.”
Contact Our Raleigh Professional License and Criminal Defense Attorneys Today
If you are a licensed professional facing criminal charges in the Raleigh area, we encourage you to contact us for a confidential initial consultation. To speak with our professional license and criminal defense attorneys about your case, call (919) 833-3114 or inquire online today.