Violations of standard of care can be the basis for a false claim or false statement allegations, and the defense of these allegations proves more difficult. The concept of standard of care can be vague and left to interpretation; what constitutes the correct standard of care may vary from medical provider to medical provider. The difference between not providing a service and providing exceptional service may seem obvious, yet what about the levels of care in between?
Standard of Care is the level of care at which the average, prudent medical provider or health care entity in a community would practice; it is how similar practitioners and facilities would have managed the patient’s care under similar circumstances. Yet, this definition leaves much to interpretation. Who is an “average, prudent provider”? How is “community” defined? What is a “similar circumstance”?
Also, the correct level of care or treatment varies among medical providers, and because of rapid innovation, it changes over time. Experienced healthcare-based criminal law defense attorneys must be able to understand the law that applies in addition to understanding how the medical industry operates and how medical care is delivered to patients. Traditional criminal defense attorneys, meanwhile, may not possess the knowledge and experience required to drill down to the root of the allegations and to explain the intention of the health care provider.
Many times, the delivery of health care is a collective effort on behalf of several, if not many, providers. Some medical services require a prescription or referral from another medical provider in order to show medical necessity. During health care fraud investigations, federal agents can probe into the different levels and layers of a patient’s care, and it is possible that criminal charges can be waged against several individual medical providers during the same investigation.
In order to provide quality defense against criminal health care fraud charges, it is imperative that the health law attorney understand how medical care is delivered. An experienced health care defense lawyer must be able to untangle the individual providers in a patient’s care and understand the dynamics of how they all fit together. Sometimes services that are considered “medically necessary” by one medical provider, may not be considered medically necessary to another, which is why medical expert testimony is crucial. Discretion is an important part of being a treating provider, and an experienced health care law defense attorney can help medical providers craft a criminal defense that is grounded in medical theory and practice.