Detroit Healthcare Fraud Defense Attorneys

Health care fraud attorneys in Detroit Michigan.

If you’re a Detroit-based physician, pain management specialist, pharmacist, nurse, or chiropractor, and you’ve been accused of healthcare fraud, why should you have Chapman Law Group on your side?

Because our Detroit healthcare fraud defense attorneys have achieved frequent dismissals and acquittals on behalf of clients charged with federal healthcare fraud, such as Medicare, Medicaid, and TRICARE.

Detroit has one of the highest rates of federal healthcare fraud indictments in the country — so much so that in 2010 the Department of Justice created a special “strike force” to prosecute healthcare fraud in the Detroit area.

But our Detroit healthcare attorneys have been battling the Detroit Medicare Fraud Strike Force 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.

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.

How Do I Choose the Right Detroit Healthcare Fraud Defense Attorney?

Healthcare fraud — including Medicare fraud, Medicaid fraud, and TRICARE fraud — has been the main target of federal prosecutors in recent years. Defending healthcare fraud charges requires an attorney with highly specialized knowledge of this complex area of law — as healthcare fraud statutes and safe harbor provisions are complex and ever-changing.

Because of the government’s emphasis on prosecuting healthcare fraud cases, it has been pushing the envelope in charging decisions resulting in weaker charges, with less evidence, that are more defensible for an attorney with medical and healthcare knowledge.

Unfortunately for those facing healthcare fraud charges, this fact has resulted in more cases proceeding to costly trials.

However, a skilled healthcare defense attorney with a focused approach to the case can drastically save the time and money necessary to defend healthcare fraud charges.

And that is where Chapman Law Group comes in.

Our White-Collar Defense and Government Investigations practice group is led by a former federal prosecutor and staffed with attorneys who exclusively defend healthcare fraud cases.

Many of our attorneys 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.

No other national law firms — let alone firms in Detroit — that handle criminal law matters have this level of dedication to one particular practice field.

Healthcare fraud attorney in Detroit Michigan.

What is Healthcare Fraud?

Healthcare fraud is simply making a false claim to a healthcare benefit program. These programs include Medicare, Medicaid, TRICARE, and insurance carriers such as Blue Cross Blue Shield.

Healthcare fraud can be committed by anyone who bills or causes a bill to be submitted to a healthcare entity. This definition is very broad, and it does not require that someone actually submit a bill to a health benefit program.

In order to be convicted of healthcare fraud, the government must prove, beyond a reasonable doubt, that the defendant: 

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

Many attorneys who do not specialize in healthcare fraud are unaware that violations of billing requirements, such as local coverage determinations (LCDs) or national coverage determinations (NCDs), are insufficient, alone, to satisfy this requirement.

Despite this fact, the government and the Department of Justice (DOJ) Healthcare Fraud Strike Force continuously charge healthcare providers with healthcare fraud charges for differences of opinion related to the practice of medicine or pharmacy. These include:

  • 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)

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 Prosecuted?

Healthcare fraud is predominately prosecuted by the federal government and the DOJ Healthcare Fraud Strike Force. The following laws are utilized by the federal government to prosecute healthcare fraud:

Typically, a healthcare fraud indictment, which is the document that charges healthcare fraud, contains a charge of healthcare fraud conspiracy along with several individual executions of healthcare fraud. The indictment may also contain a money laundering charge in addition to a forfeiture charge.

The government charges healthcare fraud conspiracy because the federal conspiracy rules are extremely relaxed; they only require that the government prove an agreement to commit healthcare fraud and an act in furtherance of the scheme. 

The government also makes attempts to seize a significant amount of assets of those charged with healthcare fraud, chiefly to prevent the defendant from using allegedly unlawful proceeds to defend healthcare fraud charges.

Who Investigates Healthcare Fraud?

Healthcare fraud is investigated by the following agencies:

  • DOJ Healthcare Fraud Strike Force
  • Health and Human Services Office of Inspector General (HHS-OIG)
  • Federal Bureau of Investigation (FBI)
  • Drug Enforcement Administration (DEA)
  • The Appalachian Regional Prescription Opioid Taskforce
  • Local Medicaid fraud control units (such as the Detroit Medicare Fraud Strike Force)
  • State Medicaid fraud control units

Typically, healthcare fraud is initially investigated using data. The Centers for Medicare & Medicaid Services (CMS) and HHS review statistical data generated from Medicare and Medicaid bills to look for outliers.

If you believe your practice is an outlier, contact us at Chapman Law Group to begin your defense immediately, as quick action and a compliance plan may prevent indictment.

Once the OIG or CMS finds an outlier, it typically conducts an audit and, in severe cases, may immediately refer a case for criminal prosecution.

During an audit, HHS will obtain billing records and request medical records. An initial audit may require review of only a few files, often called a probe audit.

If fraud is suspected after an audit, the case will be referred for investigation and prosecution. When the case is referred, federal law enforcement agents will begin investigating the billing data and interviewing witnesses in order to prepare a case.

Once the case is prepared, an attorney from a local U.S. Attorney’s Office or the Healthcare Fraud Strike Force will prepare an indictment and take a case to a grand jury. If the grand jury returns an indictment, the subject of that indictment will be charged with healthcare fraud and will be required to defend that indictment in court.

How are Healthcare Fraud Charges Defended?

When a healthcare professional is indicted for healthcare fraud, the government has probably completed a thorough investigation.

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.

If an indictment has been issued, counsel must work quickly to analyze insurance claims, patient records, witness statements, and the government investigation.

At Chapman Law Group, our attorneys defend healthcare fraud charges by first reviewing the medicine in order to make the case that the claim was properly billed or, at the very least, not billed with the intent to defraud. Such a defense requires expert testimony from a certified biller and a health professional of the same profession, to testify that the medical decision-making was not fraudulent.

If the argument cannot be made that the medical decision-making is defensible, we review the Medicare bills to argue that the amount of the fraud (called the loss amount) was so low that it is not evidence of a scheme.

If a trial is necessary, it is imperative that expert testimony is presented to assert that the claims were not fraudulent. It also is vital that certain motions and objections are made that would restrict the government’s evidence in order to improve your chances of a successful outcome.

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

The initiation of healthcare fraud charges begins with the unsealing of a federal indictment. An indictment is issued by a grand jury and is then kept sealed until the prosecutor is prepared to arrest and process all defendants.

Once the indictment is unsealed, all defendants will either be arrested by federal agents, or their attorneys will be notified of the need to “walk in” for arraignment.

This is one reason why it’s imperative to contact a Detroit healthcare fraud defense lawyer 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.

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 healthcare fraud defense attorney 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: Arraignment simply means being 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.
    5. Discovery Phase: The prosecution will provide your counsel with discovery, which is information obtained during the investigation. During this time, your counsel also conducts an investigation. (Be wary of any defense counsel who doesn’t conduct their own investigation and simply takes the government’s word for it.)
    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 Negotiations: These should be ongoing during all of litigation. It is important to engage in negotiations with the government even if you intend to go to trial, as you can learn valuable information about the government’s theory during plea negotiations.
    8. Pre-Trial Hearing/Plea Cutoff Hearing: During this hearing, the judge hears whether you wish to accept a plea of guilty or go to trial. Usually, this is the last date for which the judge will accept a written plea agreement (called a Rule 11). You may still plead guilty without a plea agreement (called an open plea), but you will not be able to receive the benefits of a plea agreement after this date. If you intend to proceed to trial, this hearing will serve as a meeting between the prosecution, judge, and defense counsel to discuss the logistics of the trial.
    9. Trial Date: This is the date formally set for trial. A healthcare fraud trial can last anywhere from a week to several months long.
    10. Sentencing: If a plea agreement is reached or if an open plea is taken, the judge will sentence you on this date.

If you believe you are going to be indicted for healthcare fraud or have been indicted, we strongly urge you to contact us today. A Detroit Medicare fraud lawyer from Chapman Law Group 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.

Health care fraud lawyer in Detroit Michigan

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 Detroit healthcare fraud defense attorneys understand the magnitude of these ramifications on a healthcare professional’s career, and we 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

How are Healthcare Fraud Sentences Determined?

Federal sentences are created using the Federal Sentencing Guidelines. If someone is convicted of healthcare fraud, the sentence is almost exclusively determined by the fraud loss amount to the entity billed — generally the value of claims billed.

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 Detroit health care fraud defense lawyer to defend your Medicare or Medicaid fraud case.

This is why you need Chapman Law Group.

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

Because our Detroit healthcare fraud defense lawyers 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 Detroit 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, we 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.

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

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

For 35 years, the Detroit health care fraud defense lawyers at Chapman Law Group 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 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 Chicago, and from Los Angeles and Southern California to Pittsburgh.

Our clients include practitioners in cities, counties, and communities all across Michigan — Detroit, Ann Arbor, Dearborn, Grand Rapids, Troy, Lansing, Flint, Saginaw, Midland, Muskegon, Bay City, and Kalamazoo, as well as Oakland County, Wayne County, Macomb County, Washtenaw County, Genesee County and St. Clair County.

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

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Other Practice Areas​

Health Care Fraud/
Criminal Defense

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