Conspiracy and Attempts to Commit Health Care Fraud
What is health care fraud?
Health care fraud charges have been ever prevalent with the federal government and with these charges they are also going after other actors linked with the fraud.
Even if you did not commit fraud, there is a chance you may be criminally prosecuted. Under an attempt and a conspiracy, the federal government may be able to charge you criminally even though you committed no fraud.
What is a conspiracy?
Conspiracy charges are increasingly prevalent in health care fraud cases. The federal government through their investigators will try and find instances of practices working together in a scheme to defraud Medicare or Medicaid.
A conspiracy is formed when more than one person agrees to commit an offense, here if more than one person agrees to work on committing health care fraud. It is a common charge for the federal government to charge a group of people with a conspiracy when they find that a practice committed health care fraud.
The charge of conspiracy is not always proper however because even if people worked in a practice that committed health care fraud, it does not mean that they were all in agreement to commit the fraud. The federal law on conspiracy for fraud states that you will receive the same penalty as the completed offense for a conspiracy to commit an offense.
What is an attempt?
The other way you may be charged without committing an act of health care fraud is if you attempt to commit health care fraud or put into place a scheme to defraud any insurance company.
This means you might think of a plan to defraud and might take actions to try and defraud, but you might get caught before the completion. In this case, you will be charged with an attempt.
Attempts for health care fraud are treated the same way as a completed offense of health care fraud. Which means you do not have to complete the crime for you to be sentenced the same as if you committed the crime.
When do you face these charges?
Attempts and conspiracy charges are much more common when there is a completed crime of health care fraud, and the federal government is trying to charge everyone involved. While it might be easy for the federal government to prove the crime, it might be hard to link the crime to everyone involved which is where the conspiracy and attempt charges come in.
If you are under investigation or charged with any attempt or conspiracy charges related to health care fraud you should contact an attorney with experience defending against health care fraud. Our firm will work with you to get to the bottom of these allegations and help defend you.
What is a health care fraud charge?
Health care fraud charge is brought up against you when you act to defraud an insurance program. For a more detailed look into the charge of health care fraud, you can visit our page detailing the charge itself.
If you are charged with health care fraud, there is a chance you may also be charged with attempted health care fraud and a conspiracy to commit health care fraud.
What is a conspiracy to commit health care fraud?
Health care fraud is the act of defrauding an insurance company, and if you enter into a scheme to defraud with other people, you may face a conspiracy charge.
A conspiracy is formed under federal law when more than one person agrees to commit a crime, and in health care fraud it is when they agree to commit fraud against an insurance company.
18 U.S. Code § 1349 attempt and conspiracy is the federal law that makes it illegal to form a conspiracy to commit any fraud charge including healthcare fraud 18 U.S. Code § 1347. When you and any other person agree to defraud an insurance company, you are committing the crime of conspiracy, even if you never actually commit health care fraud.
What is an attempt to commit health care fraud?
The federal law punishes fraud in both the completed act of fraud and any attempt to commit fraud. This means if you attempt to defraud an insurance company and you do not get any money from the scheme because you were unsuccessful you still may be charged with an attempt to commit healthcare fraud.
18 U.S. Code § 1349 attempt and conspiracy and 18 U.S. Code § 1347 health care fraud both cover attempts to commit health care fraud. Under § 1349 you may be charged with attempting to commit health care fraud if you take a step towards completing the fraud.
Under § 1347 you may be charged with the completed crime if you attempt to put into place a scheme to defraud an insurance company.
What is the penalty for an attempt and conspiracy to commit health care fraud?
For both of these charges, you can face the same penalty you may suffer for a completed offense of health care fraud which includes jail time up to 10 years and criminal fines up to $250,000.
In addition, if anyone is injured your sentence can increase to 20 years, and if someone dies, you may face life in prison.
The federal government can not charge you with both an attempt and the completed crime, but they may charge you with the completed crime and a conspiracy to commit the crime. If you are charged with a conspiracy and the crime you may face two sentences for both crimes.
How does the federal government find conspiracies or attempts?
It is common during an investigation into health care fraud to find instances where more than one person talked about or planned to put in place a fraudulent scheme.
The crime of health care fraud does lend itself to an increased amount of conspiracy charges because most medical professionals work in a group and it sometimes takes more than one to work to defraud the insurance companies.
Attempt charges, on the other hand, are not that common for health care fraud because the federal government usually only prosecutes cases when there was money taken fraudulently from an insurance company. Sometimes the federal government may charge people with an attempt because it is easier to prove the scheme and may be harder to prove just how much fraud there was.
I’ve been charged. Now what?
Once you are charged with any health care related crime, it is important to first speak to an experienced attorney that can help guide you through the legal process involved.
Our attorneys have experience in handling all types of criminal matters including the charges of attempt and conspiracy to commit health care fraud.
After there are charges against you the next step is a grand jury hearing where the grand jury will determine if there is enough evidence to indict. Following the indictment, your attorney should prepare with you for a trial.
How can I fight these charges?
Our firm can help you to fight any charges of attempted health care fraud and conspiracy to commit health care fraud. We will work with you to get to the bottom of your case and determine what defenses are available to you.
For defenses, it is important for us to know the facts of your case to determine how to defend your case best.
The defense attempted to health care fraud.
When you are charged with an attempt to commit health care fraud, it is very hard for the federal government to meet their burden to prove you were attempting this type of fraud.
One of the best defenses you can raise for an attempt is that you never put into place any schemes to defraud. It could help to show if there was any problem that the problem did not amount to fraud; instead, it was a mistake.
My practice committed fraud, what should I do?
When you are involved in a practice that commits health care fraud, it is important for you to defend yourself because there is a chance the government may charge you as part of the practices conspiracy to commit fraud.
To defend against a charge of conspiracy when it was a practice you work at committing fraud is to show that you were never involved in the fraud. If you were involved and had no knowledge or no reasonable understanding of the fraud you may also raise this as a defense.
How can I fight my conspiracy charges?
If you were involved in a scheme to commit health care fraud, it is important to know that if there were others involved, you might be charged with conspiracy as well as fraud.
To fight against the conspiracy charge, we might argue that either you acted alone or that if anyone else was involved that their actions were taken with no knowledge or agreement to the fraud.
What are some cases of conspiracy and attempts?
Conspiracy charges are very common with most large cases of health care fraud, but attempt cases are far less common. While the federal government may charge attempts, it is far more likely that they will claim that there was actual fraud committed.
Article 1- Alcohol and Drug Addiction Treatment Center Conspiracy Fraud Scheme
In 2017 two owners, a director and a salesperson of Sober Home in Florida all plead guilty to a multi-million-dollar scheme to defraud insurance companies. This group of 4 people allegedly worked together to receive bribes, kickbacks and submitting false bills for drug testing. The four were sentenced to serve between 18 to 84 months in prison and will release between 1 to 3 years.
The Sober Homes treatment center was set up as a rehabilitation center to fight against drugs and alcohol, but it was alleged that they would allow their patients to continue to take drugs while the company was submitting to drug testing. They would offer free rooms to people with insurance in return for Sober Homes being able to bill their insurance companies for procedures.
Some of the allegations into the company went as far as to say they were coercing females into prostitution offering free rent to them. Because the people working at this facility including the owners were working together with this scheme, they all were charged not only with health care fraud but also with a conspiracy to commit health care fraud which increased their sentences.
Article 2- Opioid prescribers $300 Million Fraud Scheme
When an individual who works with controlled substances such as opioids abuses their power to overprescribe these drugs there is a good chance they will face health care fraud charges. The CEO of Tri-County Wellness Group from Ohio did exactly this when he fraudulently set up a scheme to provide about 6.6 million doses of opioids when they were medically unnecessary.
When a CEO is charged with health care fraud, there is almost a certainty that he will face conspiracy charges because he would have to act in unison with his employees to commit the fraud. The CEO of Tri-County conspired with countless physicians to have them overprescribe opioids in an attempt to make more money.
The CEO ended up pleading guilty to the charges of conspiracy to commit health care fraud wire fraud, and money laundering. He ended up having to make a $51.4 million forfeiture to the United States in agreement with his plea deal. He ended up having to forfeit all of his commercial and residential real estate and his season tickets to the Detroit Pistons.
Article 3- 11 Year Sentence handed down to Doctor in Conspiracy Fraud Scheme
When you are convicted of health care fraud and conspiracy to commit health care fraud, you might end up facing long sentences for your crimes. A Detroit area doctor in September of 2018 was sentenced to 11 years for health care fraud and for a conspiracy to commit health care fraud. He was convicted of 5 counts of health care fraud and a conspiracy to commit those frauds.
The conspiracy charges came because the doctor was working with his co-defendant, another doctor to commit fraud. Both ended up receiving about $8.9 million through all of there fraudulent claims.
The case was first found by the Medicare Fraud Strike Force that investigated and found this instance of fraud. The strike force found that both defendants were receiving kickbacks for referring patients that had Medicare to receive payments.
What should you do?
When you are a suspect of attempting or conspiring to commit health care fraud, you should contact our experienced attorneys to help you through this process. The investigations, questioning, and trials are all important parts of this case, so you need an attorney to represent you through each step.
Our experienced attorney will help guide you through the process and help defend against any of these allegations. Contact our firm today to help you against conspiracy and attempted health care fraud charges.