Different Types of Health Care Fraud

 Posted on February 21, 2019 in Fraud

Health care fraud is considered a white collar crime, but it can come with very serious penalties. Doctors and healthcare workers typically think of this type of fraud as stealing from a government healthcare program, such as Medicare. The government, however, sees it very differently. To prosecutors and federal agents, even small errors are considered fraud, and allegations that can be proven will result in strict penalties, including loss of program eligibility. It is important that anyone working in the healthcare industry understands just how broad health care fraud is. Below are ten of the most common types of healthcare fraud. Inaccurate Billing and Coding Of all the different types of healthcare fraud, inaccurate billing and coding procedures are some of the most common. Double-billing a healthcare program, billing for costs not applicable under a program such as operational expenses, and billing for services at stand-alone rates rather than bundled rates are all examples of this type of healthcare fraud. Even an unintentional mistake when applying for reimbursement from a government program is often enough to have an individual or organization charged with healthcare fraud. Penalties for committing this type of fraud include a minimum fine of $21,000 for every false claim, additional fines, and loss of eligibility for the program. Kickbacks The federal Anti-Kickback Statute makes it illegal for any healthcare provider to knowingly and willfully offer or receive any funds from a federal healthcare program in order to procure a purchase, lease, or patient referral. It is important for healthcare workers to understand that while the law states this kickback must be taken or received ‘knowingly or willfully,’ that is not always the case. Like billing and coding errors, if a mistake was made that affected funds from the federal program, healthcare institutions can be prosecuted. The term ‘knowingly and willfully’ is not the only confusing terms within this statute. There are exceptions to this law that are also not as clear. Compensation to W-2 employees, some risk-sharing and purchasing agreements, and safe harbors for certain transactions are just a few examples. A healthcare fraud lawyer can help healthcare organizations understand what is and is not a crime. Physician Self-Referrals Many areas of healthcare fraud law apply broadly to many different healthcare organizations and workers. The law pertaining to physician self-referrals applies only to doctors. This law is also known as the Stark Law. Under this law, doctors cannot refer a patient to another doctor or health service in which the referring doctor has a financial interest. False Claims While there are many different types of healthcare fraud, making false or fraudulent claims is one of the broadest. The False Claims Act makes it illegal for anyone to purposefully make false claims when applying for reimbursement from any federal health care program. This can include billing and coding errors, illegal forms of remuneration, and more. Those found in violation of the Act can face both criminal and civil penalties. Billing for Unnecessary Services, Supplies, or Equipment Federal healthcare programs are in place to provide doctors with necessary services, supplies, or equipment so those doctors can then give their patients the best treatment. In cases when a healthcare worker provides inpatient treatment beyond the length of stay Medicare approves, prescribes medications to treat a condition that does not require a prescription, or provides healthcare services in a facility when a lower-cost facility was available, these are all considered to be unnecessary billing practices. Billing for Services, Supplies, or Equipment Not Provided Just as healthcare workers cannot provide services or equipment that is unnecessary, they are also forbidden from doing so when those services are not actually provided to patients. This practice is also known as phantom billing due to the fact that healthcare workers are billing federal agencies for items never passed on to patients. Sometimes this is done intentionally by a healthcare organization but more often than not, it is a simple mistake with big consequences. Prescription Drug Fraud Prescription drug fraud has garnered a lot of attention in the past few years due to the opioid crisis. This crime can include falsifying prescriptions, selling fraudulent prescriptions, prescribing medications without first examining a patient, and more. Falsifying Patient Records and Test Results When the federal prosecution charges a healthcare worker or organization with falsifying patient records and test results, they will argue the worker did so in order to increase their profit or the profit of the facility. The truth is though, that many times there is no falsification. The records of one facility are simply far above national or regional averages. This happens more than people think as this crime relies heavily on data analytics. Fraudulent Physician Certifications This may sound like a crime in which a doctor falsifies their own certificate from medical school or other institution. However, it is not. Instead, this crime refers to beneficiaries of Medicare or other healthcare programs that require home health or hospice care. These patients must be certified every 60 days and that certification requires a physician to perform a full examination. Once the exam is finished, the physician then needs to certify that the patient still requires home care. When that certification is falsified, it is a crime. Problems with Election Statements for Hospice Care Just as hospice care patients need to be certified, they also need to sign an election statement. Within these statements, the patient will acknowledge that they have received complete and accurate information about the nature of hospice care and that they have waived their rights to Medicare coverage for treatment not provided by the hospice provider. In order to be protected from this law, hospices should always keep all election statements from their patients. Healthcare Workers Need the Illinois Federal Criminal Defense Lawyer that Can Help

Being charged with healthcare fraud is very serious. Healthcare workers can expect large fines, and could even have their license taken away. It is for these reasons that anyone accused of healthcare fraud needs the experience of a passionate Chicago federal criminal defense lawyer. If you are facing healthcare fraud charges, let the Law Offices of Hal M. Garfinkel help you beat them. We know the many laws pertaining to healthcare around the country, and we know the defenses that can be used for them. We also know that simple, honest mistakes can cost healthcare workers dearly. Call us today at 312-629-0669 for your free consultation.

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What Is Suborning Perjury?

 Posted on February 14, 2019 in Federal Crimes

When a person makes statements under oath, they have sworn to tell the truth. If they intentionally lie, they may face perjury charges. A person providing sworn testimony knowing that it was false is often the first type of perjury people think of when they imagine this crime. There is another type of perjury under federal law, however: suborning perjury.

Suborning Perjury

BuzzFeed made headlines in January with a story surrounding suborning perjury. In their report, they state Trump committed the crime of suborning perjury after directing Michael Cohen to lie to Congress. Since that publication, CNN has reported Special counsel Robert Mueller has disputed the Buzzfeed report. Still, it has gotten people asking: what is suborning perjury?

If a person encourages, persuades, or influences another person to give false testimony as a witness in a legal proceeding, they are guilty of suborning perjury. The person trying to persuade someone to lie under oath does not need to use threats in order to be changed with suborning perjury. They simply need to try and persuade someone else to give dishonest testimony.

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Options After a Federal Indictment

 Posted on February 07, 2019 in Federal Crimes

A federal indictment is a legal document charging someone with a federal crime. The prosecution can only obtain an indictment after arguing their case to a grand jury. The jury then convenes and determines whether or not there is probable cause that the individual committed the crime. If the grand jury determines there is probable cause, an indictment is issued. Receiving a federal indictment is very stressful and can cause those charged to think the worst as they imagine spending several years in federal prison. However, not every federal indictment ends this way. Those charged with a federal crime do have options, and they should discuss all of them with a federal criminal defense attorney. Dismissal This is the best chance a person has at retaining their freedom after receiving a federal indictment. When a case is dismissed in federal court, the charges are dismissed and the case is thrown out of court. According to the Federal Rules of Criminal Procedure, Rule 47, when the defense wishes to have a case dismissed, they must file a motion with the court. In order to obtain a dismissal of the case, the defense must show within their motion that the defendant should not have been charged with the alleged crime, or that their constitutional rights were violated. Obtaining a dismissal is much more difficult in federal court than it is in state court. This is due to the fact that in federal court, a grand jury consisting of 12 people has determined there is probable cause. In a state court, only one judge is convinced of probable cause. The law views the opinions of 12 people as more substantial than the opinion of just one. However, when the prosecution has a weak case, dismissals are still a possibility. Plea Deal Under Rule 11 of the Federal Rules of Criminal Procedure, the defense team and the prosecution can strike a plea deal. This is the best option when the defense believes they will not receive a successful verdict at trial. During a plea deal, the defense team will meet with the prosecution and agree to plead guilty to lesser charges in exchange for a lesser sentence. Certain sentencing factors, such as enhancements, are often thrown during the negotiation. It is important for defendants to understand that when a plea deal is made between the prosecution and the defense, the court must approve it. If the court decides not to approve it, the case will go to trial. Trial After receiving a federal indictment, many defendants think taking the case to trial is the worst option. This, however, is not always true. A jury made up of 12 people will determine a defendant’s innocence or guilt throughout the course of a trial. This means the prosecution must convince the entire jury of a person’s guilt beyond a reasonable doubt. When they fail to do so, the jury must find the defendant innocent. Going to trial is often the best chance a defendant has at beating the charges and retaining their freedom. Review Your Options After a Federal Indictment with a Chicago Federal Criminal Defense Attorney

Anyone that is indicted on federal charges may think they are out of options. This, however, just is not true. A passionate Chicago federal criminal defense attorney can help. If you have been indicted by a grand jury, contact the Law Offices of Hal M. Garfinkel at 312-629-0669. We know the many options available, and we will review them all with you to determine which one is right for your specific case. We offer free consultations, so call us today and we can begin discussing your case.

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How to Escape an ICE Audit Unscathed

 Posted on January 31, 2019 in White Collar Crime

No one ever wants to get audited. When business owners are facing an ICE audit though, it is even more intimidating. These audits are conducted by Immigration and Customs Enforcement, and the number of them have skyrocketed over the past year or so.

These audits are meant to look for undocumented immigrants that are working for a business. The law provides that businesses may hire a certain number of undocumented workers, but if more than that number is found, it can mean big trouble for the business owner.

It is important all business owners realize the possibility of an ICE audit happening in their place of business. It is also just as important that they understand how to escape one unscathed.

Do Not Lie to a Federal Agent

Most business owners likely understand that they are expected to tell the truth during an ICE audit. Unfortunately, the majority do not realize that outright lying to a federal agent is a crime in and of itself. In fact, anything said while speaking to a federal agent is equivalent to testifying in federal court. This is why everything that is said must be 100 percent truthful.

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When Is Kidnapping a Federal Crime?

 Posted on January 26, 2019 in Kidnapping

Kidnapping is typically a crime that starts at the state level. Under Illinois Compiled Statutes 720 ILCS 5/10-1, kidnapping is secretly confining someone against their will, or using deceit or secrecy to take a person from one place to another. Due to the fact that this is a state statute, those that violate the law will likely be tried in state court. There are times though, when kidnapping moves from state court and is tried in federal court as a federal crime. Conditions that Make Kidnapping a Federal Crime After the historic Lindbergh kidnapping, in which the toddler son of Charles Lindbergh was abducted and killed, the United States Congress enacted the Federal Kidnapping Act. This is often called the Lindbergh Law, or the Little Lindbergh Law. The Act makes kidnapping a federal crime when certain conditions are met. These include:

• When a child under the age of 16 is taken outside of the country by a non-custodial parent;
• A foreign official or person with international protection is kidnapped;

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Is Identity Theft a Federal Crime?

 Posted on January 17, 2019 in Identity Theft

Identity theft has become a well-known term in recent years. However, until recently it had no legal definition. It was not until the Identity Theft and Assumption Deterrence Act of 1998 that identity theft was recognized as a crime. And yes, it is now considered to be a federal crime. The penalties for identity theft are severe. Anyone charged with this crime needs to speak to an Illinois federal crimes attorney that can help with their case.

History of Identity Theft

Before 1998, identity theft was known as “false personation.” However, this crime involved someone misrepresenting their own identity rather than stealing someone else’s. False personation was very different than identity theft. While this crime may be committed so someone could avoid facing legal consequences of their actions, identity theft is nearly always about gaining access to someone else’s money.

Purpose of the Identity Theft and Assumption Deterrence Act of 1998

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What Is Insider Trading?

 Posted on January 10, 2019 in White Collar Crime

Even with the widely publicized arrest and later conviction of Martha Stewart for insider trading, many people still are not aware of what this crime entails. Many also think that it is a crime of the affluent or those that have acquired fame, perhaps due to the Stewart scandal in 2003. However, people are charged with insider trading more often than many think. So, what does this crime involve? And what are the penalties associated with it?

Insider Trading Defined

Insider trading is when an individual has a fiduciary duty to another individual, institution, corporation, or other entity and makes an investment decision based on information that is not available the general public. The decision can be made in order to profit from that investment or to avoid losses in others. In the Martha Stewart case, she sold her ImClone stocks in order to avoid a loss. Interestingly, insider trading has only been considered a crime in the past several decades. Early in the twentieth century, the Supreme Court actually called insider trading an advantage of being an executive. After the opulent 1920s, and the subsequent Great Depression, public opinion shifted, and the courts’ did as well. It was at this time that insider trading was no longer allowed, and when the Securities Exchange Act of 1934 was created.

Penalties for Insider Trading

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Federal Counterfeiting Crimes Explained

 Posted on December 29, 2018 in Federal Crimes

The term ‘counterfeiting’ can be used to describe any number of fake articles. Counterfeit art or fake commercial items such as designer apparel can all be considered counterfeits. However, these goods are not covered by federal law. So what is the federal crime of counterfeiting? And what are the penalties one may face? Being charged with the federal crime of counterfeiting is very serious. Anyone that has been accused needs to speak to a Chicago federal criminal defense attorney that can give them the best chance of beating the charges.

Federal Counterfeiting Definition

According to the U.S. Code, Title 18, Chapter 25, the federal crime of counterfeiting involves producing, possessing, and using false documents that are used to cheat the government of the United States. These include:

• Currency;
• Securities, such as stock certificates;

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What Is a Hate Crime?

 Posted on December 20, 2018 in Hate Crime Statute

According to the FBI, hate crimes in the United States rose by 17 percent in 2018. That makes it the third consecutive year that these numbers have increased. What may be even more troubling is that it has been estimated that less than ten percent of hate crimes in the country actually show up in the FBI’s data. But what exactly is a hate crime? Is it different than hate speech? And what are the penalties? Hate crimes, and their penalties, can be very serious. Anyone charged with a hate crime needs to speak to a federal crimes lawyer in Illinois as soon as possible to give themselves the best chance of success in court.

What Is a Hate Crime?

The FBI classifies a hate crime as an additional crime tied to any other offense. If a person commits murder, arson, vandalism, assault, or any other crime with an added element of bias, it is considered a hate crime. That bias could be based on someone’s religion, sexual orientation, race, disability, or gender. When these crimes are committed, and they have the additional element of bias, it is considered a hate crime. Hate crimes, in the United States, are considered federal crimes. When someone is convicted of a hate crime, they are sentenced to penalties for the original offense they committed. Additional penalties, such as longer sentencing or higher fines, are then added to that original sentence for the hate crime element of the offense.

Difference in Hate Crimes and Hate Speech

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Federal Murder Charges

 Posted on December 13, 2018 in Murder

Murder cases are often tried in state court because in general murder is a state crime. However, there are some circumstances where a murder trial will occur in federal court. These instances are spelled out in federal law and are quite specific. Federal prosecutions often have a larger budget and a different set of laws will be in effect. It is important that the accused hire counsel that can mount a strong defense and who fully understands federal laws of evidence and the elements of federal crimes.

Ten Types of Federal Murder Charges

1. Killing of an elected or appointed federal officeholder. Federal charges will result if the victim is a congressman, senator, president, vice president, a cabinet officer (for example Secretary of Defense), or a Supreme Court justice.
2. Killing of a federal judge or law enforcement officer. If the victim is a federal judge or a federal law enforcement officer, the trial will be heard in federal court.

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