Chicago Healthcare Fraud Defense Attorneys

Image of downtown Chicago where Chapman Law Group practices health care fraud defense.

Chicago is recognized as a home to exceptional healthcare providers and services throughout Illinois, the Midwest, and the U.S. Unfortunately, as a major metropolitan area with many individuals utilizing federal and state healthcare program benefits, Chicagoland has also become a major target for healthcare fraud investigation and prosecution.

It has one of the highest rates of federal healthcare fraud indictments in the country — so much so that, since 2010, the U.S. Department of Justice (DOJ) has operated a “strike force” to prosecute healthcare fraud in and around Cook County.

And if you’re a Chicago-based physician, pain management specialist, pharmacist, nurse, or chiropractor, and you receive a grand jury subpoena or are contacted by a federal agent for a healthcare fraud investigation, your whole career is at stake.

You could be facing more than just hundreds of thousands of dollars in fines and decades of prison time. You also could lose your license. Your business and personal property could be in forfeiture.

That’s why so many Chicagoland healthcare providers have a criminal health care fraud defense lawyer from Chapman Law Group on their side.

We have honed our expertise in defending providers against healthcare fraud charges by obtaining pretrial dismissals, not-guilty verdicts, and beneficial plea agreements in federal courts across the U.S. — from Miami to Detroit, and from Los Angeles and Southern California to Pittsburgh.

We have a unique depth of knowledge of the investigating agencies, their methods of operations, and their weaknesses. We have the tools needed to get the best results for providers accused of Medicare, Medicaid, TriCare, and insurance carrier fraud.

Many of our Chicago health care fraud defense lawyers have earned advanced degrees in healthcare law from Loyola University Chicago School of Law — the top school in the U.S. for health care law.

We know what it takes to win even the most complex healthcare fraud case — because healthcare law is all we do.

As part of our service to you, even before you contact us, we want to help make sense of what healthcare fraud is all about, how investigations take place, and the paths cases can go.

What is Healthcare Fraud?

Healthcare fraud is broadly defined as making a false claim to a healthcare benefit program. This can include anyone who bills or causes a bill to be submitted to Medicare, Medicaid, TriCare, or an insurance company.

The breadth of that definition allows the government to charge any person that it believes it can prove: 

  • devised a scheme or artifice;
  • to defraud a healthcare benefit program; and
  • that the scheme was executed.

The government must prove this beyond a reasonable doubt.

A false claim may include billing for services that have not been performed, billing for something medically unnecessary, upcoding, and using improper CPT codes.

But a Chicago health care fraud defense lawyer from Chapman Law Group, unlike a general criminal law attorney who does not specialize in this area of law, is able to quickly identify the weaknesses in the government’s case. To build a strong defense using case law, rules, regulations, statistics, and experts to hold the government to their high burden of guilt beyond a reasonable doubt. To make sure you are not convicted merely over a difference in opinion over:

  • Exceeding opioid prescribing guidelines
  • Exceeding urinalysis testing guidelines
  • Exceeding guidelines for back injection
  • Improper entries into medical records
  • Upcoding
  • Unbundling
  • Billing improper CPT Codes (99211-5)
Image of the Chicago skyline where Chapman Law Group defends physicians against health care fraud claims.

What Are the Most Common Healthcare Fraud Crimes?

    • Accepting kickbacks for patient referrals. The Federal Anti-Kickback Statute (AKS) prohibits offering or providing anything of value to induce the referral of Medicare or Medicaid business.
    • Submitting false or inflated claims to federal healthcare programs such as Medicare, Medicaid, and TriCare.
    • Billing for services or durable medical equipment not provided.
    • Billing for more expensive services or procedures than were actually provided or performed.
    • Performing medically unnecessary services solely for the purpose of generating insurance payments.
    • Making false statements on applications or contracts to participate in Medicare or Medicaid programs.

How is Healthcare Fraud Investigated?

Most federal healthcare fraud investigations happen by way of audits, whistleblower tips (also known as Qui Tam matters), or patient complaints.

Healthcare fraud is investigated by various federal, state, and local agencies. These investigative agencies include federal agencies such as the Federal Bureau of Investigation (FBI), the Department of Health and Human Services Office of Inspector General (HHS-OIG), and the Drug Enforcement Administration (DEA).

Members of these federal agencies and local law enforcement may collaborate through a taskforce or unit such as a Medicare Fraud Strike Force, which operate out of 13 regions throughout the country, one of which is Chicago. Another strike force, based in the Appalachian Region, concentrates on illegal opioid prescribing.

At the state level, Medicaid Fraud Control Units, usually composed of members of the State Attorney General’s Office, investigate healthcare fraud. Additionally, local law enforcement may participate in a larger healthcare fraud investigation or conduct their own through a unit, such as the Illinois State Police Medicaid Fraud Unit.

How is Healthcare Fraud Prosecuted?

Healthcare fraud is usually prosecuted by the U.S. Attorney’s Office in the DOJ and the DOJ Healthcare Fraud Strike Force, as a violation of federal law. There are criminal charges specifically aimed at healthcare professionals:

In addition to these charges, the government will include a notice of forfeiture to seize all assets related to the alleged fraud, in an effort to keep the defendant from being able to marshal the funds to mount a successful defense. 

Healthcare fraud may also be prosecuted in relation to a healthcare professional’s prescribing habits under the Controlled Substances Act (CSA). The government relies on vague requirements that a provider violates the CSA when a controlled substance is not prescribed for a legitimate medical purpose, and when the prescriber is acting outside his/her usual course of professional practice. These terms are not clearly defined and are very subjective.

At Chapman Law Group, our Chicago healthcare fraud defense lawyers are experienced in defending cases related to prescribing habits, and we understand that a difference in medical opinion does not automatically equate criminal intent on the part of the medical professional.

We know that each patient’s case is unique, and treatment must be tailored to the individual’s diagnosis and medical history.

In building a defense, we utilize medical experts to thoroughly review the patient charts and analyze the treatment decisions for each patient. We hold the government to its burden of proving the practitioner’s subjective intent regarding his/her prescribing habits, and we rebut the government’s overuse of generalized standards that often leave out consideration for the provider’s particular practice and patient population.

When Should I Contact a Healthcare Fraud Defense Attorney?

The earlier you contact a healthcare defense attorney, the more quickly your defense team can get to work building the strongest case.

The moment you receive a target letter from the DOJ or are contacted by federal agents is a good time to consult a Chicago health care fraud defense attorney from Chapman Law Group. By developing a defense strategy while the case is still in the investigatory stage, there is a better chance of resolving the case before any formal charges are filed.

At Chapman Law Group, we have the skills and resources necessary to conduct our own review and investigation of the billing, prescribing, or other practices in question. We can then take our findings to the prosecution and work toward the goal of reaching a resolution that does not involve indictment.

Our Chapman Law Group health care fraud defense lawyers are skilled in defending cases in every stage of the criminal adjudication process from investigation and indictment, to trial and sentencing.

What Does It Mean to Be Indicted for Healthcare Fraud?

An indictment is the formal start to a healthcare fraud prosecution. A grand jury is presented with evidence and makes the decision over whether to issue an indictment, which is kept under seal until the prosecutor is ready to move forward with the case. Once the indictment is unsealed, the defendants named in the indictment will be arrested.

By retaining a healthcare fraud attorney before indictment and arrest, this process can be much less intimidating. A great defense to healthcare fraud requires early intervention at the earliest possible stage. If an indictment has not been issued, a thorough investigation and compliance plan may remedy the issue before indictment.

Our healthcare attorneys at Chapman Law Group have developed a professional rapport with many prosecutors and are often able to arrange that we are notified before an arrest is made, and instead have our clients voluntarily walk in for their initial appearance.

Image of downtown Chicago where Chapman Law Group practices health care fraud defense.

I Have Been Charged with Medicare Fraud. What Will Happen to Me?

Once the indictment is unsealed and you are formally charged, you and any co-defendants will either be arrested by federal agents, or your attorney(s) will be notified of the need to “walk in” for arraignment.

This is one reason why it’s imperative to contact a Chicago healthcare fraud defense attorney who is familiar with the prosecutor. We may be able to prevent arrest on the indictment and request that you “walk in” for initial appearance without the embarrassment that an arrest from your home or work will cause.

This begins a series of stages in the adjudication process leading to the resolution of the case in one of three ways: trial, negotiation and acceptance of a plea offer, or a dismissal. Here are the general steps during the progression of a healthcare fraud case:

    1. Pre-Indictment Investigation: This is not just when the government investigates, but also when your defense attorney conducts an investigation and makes preparations to engage in pre-indictment negotiations. During this phase, you and your attorney have the best chance of convincing the government not to pursue a healthcare fraud case.
    2. Indictment: The unsealing of a federal indictment triggers federal criminal charges and the trial process. During this phase, the case will move very fast, which is why it is imperative to have a Chicago healthcare fraud defense lawyer on your team prior to indictment.
    3. Pre-Trial Services Interview: The pre-trial services division will interview you to determine whether you can be released on bond and, if so, under what conditions. Release on bond and conditions of bond can drastically change the landscape of the case, which is why you need your counsel present during the interview.
    4. Arraignment/Bond: The arraignment is the first court appearance, during which you are informed of the charges, by a federal magistrate, to determine how you will plead. The judge will then determine whether you can be released on bond and, if so, sets a bond amount. Most of our clients are released on bond and are not held in custody as the case is pending.
    5. Discovery Phase: Next, the discovery process begins as the government turns over the evidence it has gathered through its investigation. The discovery in a healthcare fraud case is usually quite voluminous, as it often contains lengthy documents such as patient records, billing data, financial statements, and pharmacy dispensing logs. A knowledgeable healthcare attorney can analyze the government’s evidence and understand the strengths and weaknesses, which helps in developing an overall case strategy and knowing the best step to take next. For instance, this could involve filing a motion due to the insufficiency or inadmissibility of the government’s evidence, or conducting an independent investigation to dispute the government’s findings.
    6. Motions Phase: This is when your counsel files pre-trial motions designed to narrow the case, restrict the government’s evidence, or dismiss one or all charges.
    7. Plea Negotiation: Only after reviewing the evidence, researching, filing, arguing, and receiving the judge’s ruling on any relevant motions, and engaging in a thorough conversation with our client about their case, is a plea offer considered. While plea negotiations with the prosecutor are ongoing throughout the pretrial stage, we do not rush a client to accept any offer deal the government might make without careful consideration. The ultimate decision over whether to proceed to trial or accept a plea offer is the client’s choice, but we at Chapman Law Group work to ensure your determination is based on facts and not fear of the trial courtroom.
    8. Pre-trial Hearing: The defense team, prosecution and judge will meet to make a final determination over whether the case will proceed to trial, or if a plea offer has been negotiated and accepted. If a plea offer has been formally rejected, the judge will not typically accept a negotiated plea after this hearing; however, you may still choose to plead guilty as charged on a later date, but without the agreed-to terms of a plea deal. At the pre-trial hearing, the parties will discuss any outstanding business that needs to be resolved before trial, such as the logistics of the trial.
    9. Trial: The trial is the stage when the government presents its evidence to the factfinder. The factfinder is either the jury, or, if the parties agree to a trial without the jury, the judge. It is the government’s job to prove each element of the charged offenses beyond a reasonable doubt. Our Chicago health care fraud defense attorneys will develop a strategy specific to your case, while drawing from our vast trial experience to rebut the government’s allegations. After both sides have presented their evidence, the jury or the judge makes a finding of guilty or not guilty on each charged offense. A healthcare fraud trial can last anywhere from a week to several months long.
    10. Sentencing: Sentencing will occur on a scheduled date after pleading guilty or being found guilty at trial.

If you believe you are going to be indicted for healthcare fraud or have been indicted, we strongly urge you to contact us today. Your Chicago Medicare fraud lawyer will explain the entire indictment and trial process so that you can be informed during what we know to be a troubling experience for you.

How are Healthcare Fraud Sentences Determined?

Sentencing for violations of federal law is informed by Federal Sentencing Guidelines, which provide a sentencing range in months of imprisonment based on a person’s criminal history and the offense itself. Various mitigating or aggravating factors can decrease or increase the sentencing range.

While the court is not required to abide by the sentencing range outlined by the guidelines, it provides a framework that is heavily relied on in courtrooms throughout the country.

Our Chicago healthcare fraud defense attorneys are skilled at calculating these guidelines. Understanding an accurate score of individual factors — such as the fraud loss amount or the drug quantity in cases involving convictions under the CSA — is important when advocating for the overall lowest possible sentence.

As a result of the Affordable Care Act, the number of claims billed to a healthcare program is considered prima facie evidence of the loss amount. In the event of conviction and in order to achieve a lower sentence, it is imperative that defense counsel challenge the notion that the number of claims billed is the amount of the loss to the government.

Every healthcare provider knows that Medicare, Medicaid, and private insurance companies do not actually pay the amount billed. Usually it is some lesser amount.

Under no circumstances should someone facing healthcare fraud charges accept the government’s recitation of the loss amount. The government’s loss number is generally inflated and created using poor methodology.

But a well-skilled healthcare fraud defense counsel will know other strategies useful for determining a lower loss amount, such as claim sampling and extrapolation.

This is precisely why you need a dedicated Chicago fraud defense attorney to defend your Medicare or Medicaid fraud case.

This is why you need Chapman Law Group.

What Are the Consequences of a Healthcare Fraud Conviction?

The consequences of a healthcare fraud felony conviction can last longer than just a term of incarceration, so it is important to weigh all your options before accepting any plea deal or deciding to go to trial. A plea to accept a felony charge for healthcare fraud or Medicare fraud should not be based solely on the potential jail time

At Chapman Law Group, our Chicago healthcare fraud attorneys understand the magnitude of these ramifications on a healthcare professional’s career and work to minimize the fallout.

In addition to a possible prison term (many healthcare fraud crimes carry a potential maximum 10- or 20-year prison sentence), a conviction may result in:

  • Mandatory felony conviction
  • Prohibition on billing any federal entity for between five years and life
  • Loss of professional license (medical license, pharmacy license, nursing license)
  • Forfeiture of all assets related to the alleged offense
  • Fines of up to $250,000 per offense
  • Restitution
  • Job loss
  • Loss of board certification status

Why Should I Call the Chicago Healthcare Fraud Defense Lawyers at Chapman Law Group If I’ve Been Accused of Medicare Fraud?

Because our attorneys have been battling these federal Medicare fraud strike forces for several years, so our healthcare clients get the kind of Medicare fraud defense no one else can offer.

We have keen insight into the feds’ and the strike force’s tactics. We can detect their weaknesses. And we know how to get results for our clients facing healthcare fraud indictments. Our Chicago healthcare fraud defense attorneys have a reputation in winning many cases by dismissal or not-guilty verdicts at trial.

We also know that fighting a case through trial places a heavy burden — emotionally and financially — on a family. And one of the critical differences between the Chapman Law Group and other criminal law firms is our focus on preventing an arrest and charges from being filed.

We actively investigate allegations and start building a defense for our clients before the case ever goes to court.

Many times, we can convince the government not to file charges, contending that our client committed no crime. In other instances, we are able to resolve a case through a diversion agreement, which results in a case dismissal. And in some situations, we can settle a case through a civil agreement and payment of a fine.

Even in situations where criminal charges are filed, we are often able to get a result that would substantially reduce the potential jail time and other penalties.

And, moving forward, our Chicago healthcare fraud lawyers can help you develop a stronger, more effective compliance program for your practice, so as to avoid accusations of healthcare fraud and be prepared if the government decides to conduct an audit.

For Healthcare Fraud Criminal Representation in Chicago, the Attorneys at Chapman Law Group Stand Apart

For 35 years, our healthcare criminal law attorneys have aggressively defended licensed healthcare professionals on criminal matters — from the internal investigation right up through trial.

We handle multistate federal criminal matters investigated by the DOJ; state felony matters; and, where criminal sanctions are possible, investigations commenced by the HHS, FBI, DEA, FDA, and DOJ.

We are solely dedicated to representing licensed healthcare providers — including physicians, pain management specialists, pharmacists, and psychologists — in criminal law matters such as healthcare fraud.

Besides having a proven track record of winning healthcare fraud cases by dismissal or not-guilty verdicts at trial, our knowledge, training, and experience ensure that we are able to do so more quickly — and with less expense — than other criminal law practitioners.

Very few law firms in the U.S., if any, can make these claims and back them up with our results.

We are proud to serve licensed healthcare professionals in Chicago and its surrounding counties and communities, including Evanston, Schaumburg, Aurora, Naperville, Joliet, Waukegan, Wheaton, Orland Park, Elgin, Cook County, Lake County, DuPage County, Kane County, and Will County.

Chapman Law Group has four national offices: in Detroit, Michigan; Miami and Sarasota, Florida; and Los Angeles/Southern California.

Contact us today to learn more about what an experienced, reputable Chicago health care fraud defense attorney can do for you, and how we are ready to help you with the best healthcare fraud defense. 

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