Legal Services for Visiting Nurses
As a visiting nurse, because you provide health care to numerous individuals, you are subject to allegations of health care fraud. If you find that you are being sued or criminally charged for federal or state related charges, you could face serious consequences.
Health Care Fraud is a Major Focus of Both the Federal and State Governments
Recently, the number of investigations to combat health care fraud has grown. As part of these investigations, the government has found that health care providers, including visiting nurses, are increasingly causing financial loss to federal programs across the country.
Visiting nurses contribute to this financial loss when they falsely claim to have provided medical services. This has resulted in the United States Government creating special units to audit and investigate health care fraud.
Our office has a group of attorneys who specialize in health care fraud as it relates to visiting nurses and we have been successful in our representation of clients throughout the country. Our health care fraud group is made up of experienced attorneys who can handle both criminal and civil allegations in both state and federal courts.
If you are a visiting nurse who has been accused of or charged with health care fraud, contact our office to speak with an experienced defense attorney for a free legal review of your case.
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Health Care Fraud Statutes That Apply To Visiting Nurses
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.
The elements of health care fraud include knowingly and willfully attempt to defraud a health care benefit program for the purpose of obtaining payment or benefit from the health care program.
Penalties For Violating the Federal Health Care Fraud Statute
As a visiting nurse, if you are found guilty for violating the basic health care fraud statute, you could be subject to:
- A fine, 10 years in prison time, or both;
- 20 years in prison if your actions resulted in serious bodily injury or death
Anti-Kickback 42 U.S.C. 1320a-7b(b)
As a visiting nurse, you could be charged with violating the anti-kickback statute if it is alleged that you had accepted money for making a referral to for additional care for a patient when the patient did not need the additional care, but you did so because of an agreement with another healthcare practitioner.
The elements of anti-kickback include knowingly and willfully soliciting or receiving any remuneration in return for referring a patient or arranging services (including goods) that are part of a health care program
Penalties For Violating the Federal Anti-Kickback Statute
As a visiting nurse, if you are found guilty for violating the anti-kick statute you are subject to up to five years of imprisonment or a fine up to $25,000 or both. These penalties can be applied to each act for which you are convicted.
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 that violates the False Claims Act, you will be subject to 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.
Criminal Punishment vs. Civil Punishment
The difference between criminal punishment and civil penalties is that they can also come with a potential prison term along with the fine that may be imposed against you. As you might have assumed, the criminal penalties are far more serious than civil penalties.
While a sentence does not guarantee prison, it is a possibility. Fines for criminal punishment focus on both punishment and restitution.
Defenses To Health Care Fraud
When you are charged with health care fraud, there are usually defenses for your actions. When a law or statute is applied against you, the person using that statute must prove elements to the statute. Coming up with a defense will be important to either getting your case dismissed or minimizing any penalties against you. Your defense will depend on the facts of your case.
One of the defenses that you could use to defend the allegations against you is that you did not have the required state of mind to commit the crime of health care fraud. Health care fraud requires that you knowingly and willfully made a fraudulent statement to defraud and receive a benefit from a health care program.
Your act could have been a mistake. If you act in fact was a mistake then you did not intend to defraud. Depending on your case, proving the mistake could be difficult if you had a pattern of mistakes. In any event, providing that you did not have the required state of mind will help defend your case.
Working with an experienced defense attorney will help you to develop a defense that is most applicable to your case. This will be detrimental to your case and future.
Visiting Nurses and Health Care Fraud In The News
Visiting Nurses Group Settles False Claims Act for $35 Million
In 2016 a New York-based visiting nurse services group settled civil fraud claims in the amount of $35 million in relation to their actions that led to false claims acts lawsuits. The claims included improperly billing the federal Medicaid program for patients who actually did not qualify for the Medicaid program. Regardless, the patients were accepted for long-term health care.
In addition, the nursing group was accused of opening various offices to solicit these ineligible patients. If the nursing group did provide care, it was considered substandard. Part of the reason the nursing group provided minimal care is that they were ill-equipped and did not have the proper tools to provide the appropriate care.
The United Stated government commented that this was because the nursing group was focused on billing rather than providing services. The United States government found and alleged that not only did the patients not qualify for Medicaid, the types of services to be provided also did not qualify.
Home Care and Visiting Nurses Group Agrees to Pay for Falsely Claiming To Provide Services
In 2017, Family Care Visiting Nurse and Home Care Agency out of Connecticut entered into a settlement with the United States government over alleged False Claims Act violations.
In bringing the lawsuit, the United States government alleged that the health care group would bill for certain services which led up to fraudulent billing to Medicaid. These services included a 60-day assessment, which requires a registered nurse to perform certain tasks.
It is alleged that when conducting these 60-day assessments, rather than having a registered nurse conduct the services, the registered nurse did not provide the assessments. The United States government alleged that this was at the direction of the owners and that the owners also told the nurses to bill for the assessment anyway.
The particular problem with the acts by the visiting nurse group is that they were skipping the 60-day assessment, that is used to determine Medicaid and Medicare eligibility. Regardless of skipping this assessment, they acted as if all of the patients should receive Medicaid for their services and continued on as so.
As part of this settlement, the government alleged that these health care fraud acts were done from 2009 to 2016, which resulted in $5,253,908 in damages that the agency and its owners had to pay back to the United States government.
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Cleveland Ohio Visiting Nurse Ordered Prison Sentence and $18 Million In Restitution
In 2015, a nurse out of Richmond Heights, a Cleveland suburb, was sentenced to eight years in prison for her role in an $18 million health care fraud scheme.
During the investigation of this case, it was found the nurse was practicing as a nurse for her mothers nursing group. The problem with her being employed by this group is based on the fact that she had already been found guilty for healthcare fraud and was already excluded from providing health care services when they involved Medicaid programs.
Regardless of her exclusions, the nurse continued to practice as a nurse while she and her mother billed them to the Medicaid programs. At one point, the Ohio Medicaid Fraud Control Unity told the nurse and her mother that she should not be providing nurse services to patients that would send claims to Medicaid.
Regardless of this additional notice, they still continued to bill Medicaid for services. The investigation of the two found that the nurse received a salary of more than $2.2 million while excluded from Medicaid programs.
What You Should Do If You Are Charged Or Being Sued For Health Care Fraud
While you should be taking steps to avoid accusations of health care fraud as a visiting nurse, there are some instances that you cannot control. In cases where you cannot control the health care fraud around you, report it.
If you find that you have been conducting your visiting nurse services in a way that may lead to health care fraud violations, then stop those practices or get advice as to whether you are actually committing fraud.
In the instance, you are sued for or charged with health care fraud, contact an experienced defense attorney as the consequences are serious and some can start at the initial stages.
 https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-settles-civil-fraud-claims-against-visiting-nurse-service https://www.justice.gov/usao-ct/pr/connecticut-home-health-agency-and-its-owners-pay-525-million-settle-false-claims-act https://www.justice.gov/usao-ndoh/pr/richmond-heights-woman-sentenced-eight-years-prison-operating-18-million-healthcare