TriCare Fraud Attorneys
Our group of experienced attorneys have years of experience in handling all forms of health care fraud-related charges. The charge of Tricare fraud is one example of a type of case we have experience in handling. If you have any questions or need representation for your Tricare fraud or any of your legal needs contact our experienced attorneys.
What is “TriCare?”
Tricare is a health insurance program for active and retired military personnel and their families. Tricare is run through the Department of Defense and is provided for members of any of the branches of the United States Military.
Any acts of fraud against patients who carry Tricare or against the Tricare insurance program itself leads to potential criminal liability. When you are dealing with any insurance, but especially government ran insurances it is important to know the law and follow it closely.
What are common criminal charges under Tricare?
Fraud charges are the most common types of charges you may face if you try to deceive Tricare to get more money. This includes the charge of Health Care Fraud and a charge under the False Claims Act. The fact that Tricare is run by the federal government means that you may face even stricter or harsher punishments then you would under a private insurance fraud.
What could make me liable for fraud?
If you are a health care provider, you have to be careful of your actions in billing Tricare b you may face criminal liability if you are filing false reports. For example, if you are making reports to Tricare for services in excess of what you actually provided you might have committed fraud. In addition, if you filed a fraudulent claim, you might face the additional charge under the False Claims Act.
Tricare is run through the federal government so any charges you may face will most likely be federal charges. You may in addition to the federal charges see some state charges for any other acts of fraud that are connected to your Tricare fraud.
Call 844-239-1234 for a
Free Confidential Case ReviewWhen do you face these charges?
When you are actively defrauding Tricare, you may get caught, and you may have to pay out a large amount of money and face jail time. The cases against you can come from an investigation by Tricare, an undercover agent in your practice or even a whistleblower from your firm filing a qui tam suit.
However, when your case comes up, it is always important to contact an attorney with experience defending against Tricare fraud. Our firm will work with you to get to the bottom of these allegations and help defend you.
What is “Health Care Fraud?”
When you defraud Tricare one charge you might face is Health Care Fraud. Health Care Fraud involves sending bills to an insurance company fraudulently, attempting to make more money than what is owed for the services you provide. 18 U.S. Code § 1347 makes it illegal to attempt to defraud any insurance company, and several schemes fall under this such as; double billing, billing for services not rendered, or receiving kickbacks.
What is a charge under the False Claims Act?
Any payments that go through Tricare can be prosecuted under the false claims act. The False Claims Act provides criminal and civil liability for knowingly making submitting false records or claims to the government.
You may face a violation of the False Claims Act if you knowingly made a false statement or misrepresentation, or if you were blatantly ignorant. This law is extremely broad and covers several forms of false records. This means that you may be charged even if you don’t know your practice is committing this type of fraud, but you should have.
What punishments might I face under these laws?
The civil penalty under the False Claims Act is $11,000 for each false claim plus up to three times the damages to the government for the claim. The criminal liability under this law can be assessed only if someone knowingly makes a false claim, and criminal punishment is a fine up to $250,000 and up to 5 years imprisonment.
The offense of Health Care Fraud comes with a sentence that includes jail time up to 10 years and criminal fines up to $250,000. If any of your patients are injured your sentence can increase to 20 years, and if someone dies, you may face life in prison. If you are not proving the proper care for your patients and you are billing for that care, you may face a long sentence.
How can I fight these charges?
If you defraud Tricare, you might face a lengthy sentence. Our firm will help you get to the bottom of your case and determine what defenses are available to you. In terms of establishing a defense, it is important for us to know the facts of your case to determine how to best defend your case.
What burden does the government need to meet to prove my case?
One defense to the charge of fraud or submitting a false claim is to show that the government has not met their burden of proof to show you did something wrong. The charge of health care fraud involves knowingly entering a scheme to defraud insurance companies, so you may argue you did not have the prerequisite intent formed to commit this crime. We will work hard to fight for your case, and part of this is proving that the government did not meet its burden.
What burden does the government need to meet to prove my case?
One defense to the charge of fraud or submitting a false claim is to show that the government has not met their burden of proof to show you did something wrong. The charge of health care fraud involves knowingly entering a scheme to defraud insurance companies, so you may argue you did not have the prerequisite intent formed to commit this crime. We will work hard to fight for your case, and part of this is proving that the government did not meet its burden.
Where there any schemes put into place or was it a mistake?
Mistakes often happen in billing, but when there are patterns or large problems, it might prompt an investigation. 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; rather it was a mistake.
The practice I worked at committed fraud, am I liable?
When your practice is committing fraud, and you work at the practice, it is important to set straight what your role in the fraud scheme was. If you were not involved and knew nothing about the fraud, you might be safe from charges. If you unknowingly participate in the fraud but did not know nor could you reasonably find out you might also have a defense. We will work with your specific situation to insulate you from the actions of those around you.
Call 844-239-1234 for a
Free Confidential Case ReviewWhat are some cases under Tricare?
Fraud cases against Tricare come up quite often because the federal government spends a lot of money to combat fraud, especial for government ran programs like Tricare. Some of the cases are outlined below.
Article 1- Largest trial for Tricare fraud case
Fraud cases against healthcare providers sometimes end up with millions of dollars being fraudulently obtained. In Florida, a pharmacist was charged with fraud of about $31 million in 2018. At the end of the trial, two of the defendants were found to be guilty and needed to pay back the federal government.
Both individuals, in this case, were ordered to pay out $31,259,252. They both were also sentenced to terms in prison of 204 months and 188 months. The two of them faced multiple charges for Health care fraud, kickbacks, and money laundering.
Of the total amount defrauded about $30 million was lost by Tricare. The company was working with veterans and billing falsely for compounds that they would not need. They would also refill prescriptions without being asked and not charge people copays.
Article 2- $65 million Tricare fraud case settled for compound medications
In 2018, a nurse practitioner pleaded guilty to a fraud scheme that took more than $65 million from Tricare. The case was brought up in a $2 billion dollar fraud investigation by the federal government that charged about 600 individuals.
According to the plea the nurse practitioner would recruit Marines to obtain certain medications when they did not need them. They then would bill Tricare for the medications. There were a total of 4,442 prescriptions written for a cost of $65 million.
For these charges, they are facing up to 10 years imprisonment and a huge fine that might raise up to $65million for restitution.
Article 3- Whistleblower leads to $10 million settlement for Tricare fraud
When you are practicing in the health industry, you might end up hearing cases about people blowing the whistle on a practice. When they do, they may end up making a percentage of all money recovered by the government for the fraud.
In 2011, three individuals came forward to report a case of Tricare fraud. When the case settled for $10 million, they got to see some money for their whistleblowing. In total, they received $1.7 million.
TriWest Healthcare Alliance Corp was overbilling Tricare for services that were provided and ended up having to pay out $10 million in the settlement. This case was resolved in civil court, but often there are criminal charges that are brought following a qui tam lawsuit.
What should you do?
When you accept government-funded insurance programs like Tricare, it is important to understand the law regarding fraud. When you are a suspect of health care fraud, you should contact our Health Law Group 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 you against any of these allegations. Contact our firm today to help you against Tricare fraud charges.