Legal Services for Medical Research Companies
As a medical researcher or an individual who conducts clinical trials for medical research, it may be shocking to you that you could be subject to health care fraud allegations.
While there have not been many instances where health care fraud has covered the area of medical research and clinical trials, the area is subject to allegations.
Because of the types of advances that you make for health care and the differences that you can make in treating patients, the United States government has taken an interest in the quality of services that you provide and the honesty that you exercise while conducting your research.
Direct Relation to Government Programs
Working in a Medicaid Funded Facility.
You could be directly related to Medicaid if you work in a Medicaid funded facility. Many of the products, supplies, and equipment can be furnished and funded by Medicaid programs.
Another form of being directly related to Medicaid is an instance when you are asked to do a set of clinical trials on a specific specimen by a doctor who is currently treating a patient.
Because some of the medical research and clinical testing that you conduct can either be funded to Medicaid or is related to Medicaid in some way, your procedures and results are subject to health care fraud statutes and prosecution by the federal government.
Indirect Relation to Government Programs
If you are indirectly related, it could be because your research is later being used by health care practitioners around the country. Your medical research and clinical trials have a purpose, and when they are successful health care practitioners rely on those results.
Health Care Fraud Generally
Health care fraud is one of the United States government’s major concerns. They are interested in whether those seeking health care actually receive the correct and high-quality treatment that they require. As a result, specific divisions have been established to audit and investigate health care fraud in an attempt to put it to an end.
If you find that you are alleged to have committed health care fraud, our law office has a health care group made up of experienced defense attorneys. This group of defense attorneys handles cases throughout the country in both Federal and State courts for both criminal and civil actions.
If you have been accused of health care fraud, contact our office for a free legal review of your case.
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Health Care Fraud 18 U.S.C. Section 1347
As a visiting nurse, you might be accused of health care fraud if it is alleged that you have tried to defraud a health care benefit program in relation to your nursing services for the purposes of receiving a benefit or good.
To prove that you have committed health care fraud, you must have knowingly and willfully attempted to defraud a health care benefit program for the purpose of obtaining payment or benefit from the health care program.
Penalties For Health Care Fraud
As a visiting nurse, if you are found guilty for violating the basic health care fraud statute, the penalties are as follows:
- A fine,
- Ten years in prison,
- Twenty years in prison, if serious bodily injury or death were involved.
False statements relating to health care matters 18 U.S.C. Section 1035
One of the health care fraud statutes includes the specific statements you make for health care matters. This statute applies when you are making statements that relate to a health care benefit program, and you falsify a material fact or make a fraudulent entry in connection with the payment or delivery of a health care benefit.
Penalties For False statements relating to health care matters 18 U.S.C. Section 1035
If you are found to have violated 18 U.S.C. Section 1035, there will be criminal penalties that apply. Making a false statement in relation to health care matters comes with a term or imprisonment of up to five years and/or a fine.
False Claims Act – 31 U.S.C 3729-3733
The false claims act is the civil counterpart to the criminal health care fraud charge. Essentially, as a visiting nurse, you can be civilly sued for claiming that your provided nursing medical services to a patient even though you really did not conduct nor complete any services.
Penalties For Violating The False Claims Act
Once you are alleged to have committed an act that violates the False Claims Act, you will be subject to civil penalties in the form of a fine that generally will range from $5,000 to $10,000. Each case is different, and the type of fine will vary depending on your particular your case.
It is important to know that this fine is merely a statutory fine, but there could be additional fines that could be ordered depending on the damages sustained by the government due to your actions. Even in situations where you enter into a settlement, fines are likely.
Preparing a Defense for Health Care Fraud
Even if you are alleged to have committed health care fraud for your medical research and clinical trials, you may have a way to defend your case. In law related matters, regardless if they are civil or criminal, to prove that you have done what you are accused of, your accuser must prove elements of a violated statute.
In response to these allegations, you can attack the elements of a statute with an applicable defense. Defenses can come in various forms.
Specifically, in your area where you are conducting various tepees of research and tests, many of the final results call for some interpretation of each sample. Rather than you trying to commit fraud, there could be a disagreement in your interpretation of the results. This kind of argument could attack any argument that you had the intent to violate the health care fraud statutes.
Additionally, because of this disagreement on the interpretation of results, there could be a knowledge defense as well. When the results are your actual interpretation of the research and tests that you conducted, then you did not knowingly make a false or fraudulent statement.
The facts of your case will determine whether your medical research and clinical trials resulted in health care fraud. However, our experienced defense attorneys can work with you and after a thorough review of your case can help you come up with a defense that could either get your case dismissed or minimize penalties.
News Reports on Medical Research and Clinical Trials Being Alleged of Health Care Fraud
Cancer Researcher Admits To Making False Statements About Cancer Research
In 2017 a Pennslyvania medical researcher pleaded guilty to making false statements in health care matters.
As part of the guilty plea, the medical researcher admitted that he was tasked with performing gene mutation tests specifically for advanced stage cancer patients from 2013 to 2014. The purpose of the research was to assist doctors in diagnosing the particular type of cancer that a patient has in order to find the correct treatment to administer.
In his admission, the medical researcher stated that he was untruthful to the medical center administrators about how he performed these gene mutation tests. Specifically, he did not follow their standard operating procedures because he did not use a specific device that would quantify the DNA and also because he did not preserve DNA and tissue samples.
As a result of the guilty plea, this medical research was ordered to 15 months of federal prison, followed by three years of probations, and paid restitution in the amount of $69,742.
False Statements By Researcher Lead To Health Care Fraud Conviction
In 2015 a doctor who was a researcher for a university was sentenced after pleading guilty for making false statements to the National Institutes of Helah in relation to health care fraud.
Originally, it was alleged that while the doctor was tasked with researching, experimenting, and conducting clinical trials on an HIV/AIDS vaccine. The doctor falsified his results to make it look the like the particular vaccine either neutralized or controlled the HIV/AIDS virus. However, a further look into the results was that the vaccine did not return these results.
In addition, the original indictment alleged that the doctor went further in his false statements by manipulating specimens which made it looked like there was a reaction to the vaccine, and that the specimens were producing neutralizing antibodies to fight the HIV/AIDS virus.
The doctor admitted that to providing these falsified reports. He admitted to submitting this false data to the National Institutes of Health for a grant application and grant progress reports in order to secure and renew grants. As part of this plea, this doctor was ordered to pay $7,216,890.12 in restitution and will serve three years in prison followed by probation.
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What To Do If You Are Accused Of Health Care Fraud
Allegations of health care fraud could be easy for you to prevent. As a scientist and academic, you are well aware that it is necessary to provide support for your findings. Always document your research and record all clinical test conducted.
In the instance that you have been alleged of health care fraud for your medical research and/or clinical trials, it is important to see what specifically is being accused. Determine whether you left something out of your reports, or did not conduct your research in a way it should have been carried out.
If you are sued or charged with health care fraud, contact our law office to speak with an experienced defense attorney in the health care group.