Legal Services for Medical Accountants
How are medical accountants held liable?
Medical accountants can face similar charges to medical professionals. Over the past decade, the federal government has been vigorously pursuing charges of health care fraud. This includes indictments and investigations into medical accountants.
What are common criminal charges against Medical Accountants?
Medical accountants have a unique position in the medical field because they are the ones who deal with assisting medical professionals with billing insurance companies. Because of their role they are potentially liable for the actions of the doctors insofar as the doctor is trying to fraudulently bill insurance companies.
As an accountant, there are other specific rules and regulations you must follow, but the claims you may face for your practice of health care fraud or false claims might end up being one of the most serious charges against you.
What could make me liable for fraud?
There is a fine line for accountants between liability for a doctor’s fraudulent scheme and just filling the accounting for the doctors. When another actor is trying to defraud the system, and you know or should know about there scheme you may be found to be an accomplice or a co-conspirator of the charge of fraud.
Accountants have a particular problem with hiding their head in the sand because they get all of the billing information from the doctors and if there are problems, they might know while preparing the accounting that there is a problem.
Another common way they are charged is that there was an agreement between the accountant and the facility to create false bills to make more money. If the accountant is getting more money through billing more often, they have a financial incentive to bill more, but they may be charged with fraud.
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.
How do the actions of the accounting firm I work at impact me?
Individual accountants in their work with medical professionals often work for accounting firms. If your firm or people at your firm are in trouble for the fraud, you should work to insulate yourself from any potential fraud charges.
It is essential to understand if you are following the law and do not know or have no way of knowing fraud is going on you have a valid defense to any fraud charges.
Additionally, if you are under investigation, you should work with a lawyer to go through what your actions where and what you know to come up with your best defense.
What is Health Care Fraud?
Health care fraud involves sending bills to an insurance company fraudulently, in an attempt to make more money than what is owed for the services you provide.
Health Care Fraud 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 Medicare and Medicaid through fraudulently 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.
As an accountant, if you send these entities any false bills, you may be able to be held liable, even if you are acting on behalf of a doctor.
The violation of the False Claims Act may be knowingly, or if you are blatantly ignorant, you may be held liable under this law. 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 nursing home is committing this type of fraud, but you should have.
What punishments might I face under these laws?
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.
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.
How can I fight these charges?
We will be able to fight for you to defend you against these fraud claims. Our firm will help you get to the bottom of your case and determine what defenses are available to you.
To prepare an effective defense it is important to speak with an attorney with experience defending health care professionals. Health care fraud cases are extremely complicated. If you suspect that you are under investigation don’t delay speak with an attorney as soon as possible.
Can an accountant be charged with fraud if a doctor provides false information?
Insulation between the fraud of a doctor and the accountant can get tricky legally. When the accountant is acting on behalf of the doctor, and they truly have no knowledge or could reasonably find out if the bills they are preparing are fraudulently made you may have a defense.
If you do, on the other hand, knowledge of the doctor’s offices fraud or you participate in the fraud you most likely will face criminal charges.
What does the government have to prove in a health care fraud case?
Another possible 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.
If my accounting firm is under investigation for fraud, what should I do?
It is important for you to defend any claims that might arise against you. If one of your accounts caused a problem that caused your firm to face potential fraud charges you too may be looped into the fraud charges.
As an employee, your interests might not always align with a company, and our experienced attorneys will be able to help guide you through these charges.
Cases against Medical Accountants in the News
124 Individuals charged in Florida for Health Care Fraud
Large health care fraud schemes that exist between multiple companies end up reeling in a large number of convictions. Accounting firms can be lumped into these problems of fraud when they work with these medical companies.
In Florida, a large scheme was busted when 124 people were charged with fraud in a $337 million fraud scheme. Part of the problem was that the accounts were not set to reflect the services that were performed accurately.
When a company is dealing with accounting falsified reports, they may face fraud charges along with the doctors. This case they were shipping 13 million illegal doses of opioids, which is usually a problem for doctors but there could be charges to the accountants as well if they know of the schemes.
Accountant pleads guilty to fraud
Accountants are not insulated from fraud just because they only deal with numbers. In New Orleans, a medical clinic owner pleads guilty to a $50 million fraud scheme, and the accountant the clinic used was also liable for this fraud.
The accountant for the clinic was working in conjunction with the owner to fabricate records such as tax and personal records to try and divert from the kickback scheme they had set up. The accountant accepted a plea deal that was given to him and admitted his involvement in the $50 million scheme.
Accountant in charge of a medical reimbursement program charged with fraud
As a medical accountant, if you are creating the fraud yourself, you too may be held liable. In Louisiana, an accountant was convicted with multiple charges of fraud for using a program to try and defraud insurance companies.
He pleads guilty to charges in October 2018 and could face a sentence of up to 5 years, a fine of $250,000 and three years supervised release. The problem with accountants is they have the ability to change bills quit easily.
All accountants who create schemes to make themselves or their medical professionals more money can face certain problems with health care fraud laws. It is important to know what liability you have if you make any changes to medical professional’s bills.
What should you do?
When you are a suspect of health care fraud as a medical accountant, 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.