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Can Healthcare Fraud Charges Be Dismissed?

Short answer:  It is very unlikely. Once the government, particularly the Department of Justice has brought charges, it is very rare for a dismissal to occur. That is the reason for retaining experienced counsel as early in the process as possible. 

A healthcare fraud indictment can be both devastating and overwhelming. If you or your organization has been charged with such an offense, you are probably grappling with enormous apprehension, questioning what is next. Can the charges be dismissed? And if so, how?

In this article, we’ll explore various legal defense options available and shed light on effective strategies we can use to build a robust defense. 

While every case is unique and outcomes can vary, healthcare fraud charges are rarely dismissed. Experienced healthcare fraud defense attorneys can exploit loopholes, challenge the legal basis of the charges, question evidence and witness credibility, and implement effective sentencing mitigation strategies when necessary.

With over 40 years of experience practicing law, Mr. Richard A. Serafini is a federal criminal defense lawyer who can help you through the process.

Legal Grounds for Dismissing Healthcare Fraud Charges

When facing healthcare fraud charges, individuals may wonder if it is possible to have the charges dismissed. While every case is unique and outcomes depend on specific circumstances, there are  legal grounds that can be explored to attempt to gain the dismissal of these charges. By challenging the legal basis of the charges and identifying prosecution overreaches, defense attorneys can formulate strategies to advocate for dismissal or reduction. Moreover, in very rare instances defense counsel may be able to convince prosecutors of factual errors underlying the charges. All of these factors highlight the need to retain counsel early in the process. Defense counsel is much better able to prevent the bringing of charges than to prevail in attempts to have charges dismissed once brought.

Challenging the Legal Basis

To successfully challenge the legal basis of healthcare fraud charges, defense attorneys scrutinize the charges to ensure they meet sufficient legal grounds. They carefully examine the elements required to prove fraud, such as intent, misrepresentation, or deceit, and analyze whether these elements are present in the case at hand. If there is a lack of evidence supporting these essential elements, attorneys can argue that the charges should be dismissed due to insufficient legal foundation. In practice, it is rare that the government gets the legal grounds for healthcare charges wrong, having established sufficient basis long before charging a defendant.

Moreover, defense attorneys also search for cases where the government may be overreaching its authority in charging healthcare fraud. They investigate whether there are jurisdictional issues or instances where the government applied overly broad interpretations of laws. By pinpointing such overreaches, defense lawyers can challenge the validity of the charges and seek their dismissal. This is most effective when the government is establishing a new or novel theory of prosecution.

For instance, if it can be demonstrated that certain billing practices were conducted based on ambiguous medical coding guidelines or were simply billing errors rather than intentional fraudulent actions, this could weaken the prosecution’s case.

By questioning and challenging the legality and evidence of healthcare fraud charges, defense attorneys try to safeguard their clients’ rights and pursue favorable outcomes. It is through rigorous examination of every aspect of a case that potential weaknesses in the government’s evidence and arguments can be exposed and leveraged in favor of the defendant for possible dismissal.

Identifying Prosecution Overreaches

When facing healthcare fraud charges, it is crucial to evaluate the prosecution’s actions and assess whether they have overreached in their case against you. Identifying potential overreaches can form a solid foundation for your defense strategy. Key areas to scrutinize include:

  1. Insufficient evidence: Review the evidence presented by the prosecution to determine if it establishes your guilt beyond a reasonable doubt. Look for weaknesses or gaps that could weaken the case.
  2. Illegal search and seizure: If there were violations of your Fourth Amendment rights during the investigation, such as an unlawful search or seizure of documents or information, it could be grounds for a motion to suppress evidence.
  3. Selective prosecution: Analyze whether you are being unfairly targeted due to personal bias, discrimination, or other improper reasons. Selective prosecution claims can be effective in certain circumstances. Please keep in mind that prosecutorial discretion is not selective prosecution. Prosecutors have discretion to bring cases that they feel warrant prosecution. For a successful selective prosecution motion an inappropriate reason for bringing the case must exist.
  4. Violation of attorney-client privilege: Assess whether the government violated your rights by improperly obtaining privileged communications between you and your legal counsel.

By thoroughly scrutinizing these aspects and potentially uncovering prosecutorial overreach, you can lay the groundwork for a strong defense against healthcare fraud charges.

Proven Defense Strategies against Healthcare Fraud Charges

Mounting a defense against healthcare fraud charges requires careful strategizing and expertise in navigating complex legal terrain. While each case is unique, several defense strategies have yielded positive outcomes for defendants:

  1. Lack of intent: Argue that you did not knowingly or willfully engage in fraudulent activities but rather made errors or omissions unintentionally. This is more complex than it might seem. An experienced defense attorney will determine the level of intent or knowledge legally necessary for conviction under the particular statute charged.
  2. Misinterpretation of billing regulations: Establish that any discrepancies in billing were due to ambiguous regulations or coding complexities, making it difficult to fully comply with all requirements.
  3. Inadequate documentation: Show that any deficiencies in medical records or billing documentation were unintentional rather than indicative of fraudulent intent.
  4. Expert witnesses and professional opinions: Employ the expertise of qualified professionals who can testify on your behalf, challenging the prosecution’s assertions and offering alternative explanations or interpretations.
  5. Negotiating plea agreements: Explore the possibility of negotiating a plea agreement for reduced charges or penalties, minimizing potential consequences.

Remember that specific defense strategies should be tailored to your circumstances and supported by a thorough analysis of the evidence and legal precedents applicable to your case. Consulting with an experienced attorney experienced in healthcare fraud defense is critical to ensuring you have a comprehensive and effective defense strategy.

Sentencing Mitigation Strategy

When facing healthcare fraud charges, individuals often seek to mitigate the potential consequences through a sentencing mitigation strategy. This strategy aims to present arguments and evidence that can lead to a reduction in the severity of the sentence imposed by the court. When we highlight certain factors or circumstances, defendants can demonstrate their remorse, cooperation, role in the offense, rehabilitation efforts, and other personal characteristics, which might influence the judge’s decision.

An effective sentencing mitigation strategy may involve emphasizing the defendant’s lack of prior criminal history, the contributions to society outside of the charged offense, or any positive changes made since the alleged fraudulent activities occurred. It is important to consult with an experienced attorney who can help tailor a personalized strategy based on the specific details of the case.

  • In a 2019 report by the Department of Health and Human Services (HHS) and Department of Justice (DOJ), over 800 healthcare providers faced legal action for fraudulent activities amounting to nearly $2.5 billion. Yet, thanks to strong legal defenses, only about 43% of these cases resulted in convictions.
  • The National Health Care Anti-Fraud Association estimated that the US loses tens of billions of dollars annually due to healthcare fraud; however, exact prosecution and dismissal rates are hard to find, indicating the complexity and challenges in managing and litigating healthcare fraud cases. The amount of these losses is largely the reason that prosecutors continue to view healthcare fraud as an area of emphasis.

The Role of Knowledge and Intent in Healthcare Fraud Prosecutions

When it comes to healthcare fraud prosecutions, intent plays a significant role in determining guilt and, therefore, the potential penalties. Intent refers to the state of mind possessed by the individual accused of committing fraud. In these cases, prosecutors must prove beyond a reasonable doubt that the defendant knowingly and willfully engaged in fraudulent activities with the intent to deceive or defraud. These are terms of legal art that often have meanings at variance with their usual dictionary definitions.

It is crucial to recognize that intent can be challenging to establish conclusively. Prosecutors typically rely on circumstantial evidence such as false documentation, misleading statements, or patterns of behavior to support the claim of intent.

For instance, if a healthcare provider consistently submits claims for services that were not provided or exaggerates the severity of patients’ conditions to increase reimbursements, it could indicate fraudulent intent. In this regard prosecutors could try to establish this fact by demonstrating that the medical notes did not support the level of services billed.

However, defendants may argue that any errors or mistakes were unintentional and not indicative of fraudulent motives. They might claim billing discrepancies resulted from clerical errors or misunderstandings rather than deliberate deceit. Careful review of patient progress notes is important in establishing this defense. This defense strategy asserts that without the requisite intent, the charges of healthcare fraud should be dismissed or reduced.

Mitigating Consequences: Advocacy for Reduced Sentences

When facing healthcare fraud charges, the potential consequences can be severe. However, it is important to remember that legal defense options are available to mitigate these consequences and advocate for reduced sentences. Engaging in strategic advocacy can make a significant difference in the outcome of a case.

One approach to advocating for reduced sentences is by emphasizing the unique circumstances surrounding the alleged healthcare fraud. Each case is distinct, and factors may warrant leniency or a more compassionate judgment. This could include demonstrating that the accused, while legally responsible, did not have malicious intent or took steps to rectify the illegal actions.

Another aspect of advocacy for reduced sentences involves highlighting the defendant’s character and contributions to society. This can involve showcasing the positive reputation within the community, philanthropic efforts, or dedication to patient care. Painting a full picture of the defendant as someone who has made valuable contributions can humanize him to the court, potentially leading to a more merciful outcome.

Moreover, engaging in restorative justice practices can also demonstrate a commitment to making amends and preventing future occurrences of healthcare fraud. This might involve offering restitution, participating in educational programs, or implementing safeguards within the practice or implementing procedures to ensure compliance with regulations.

Ultimately, successful advocacy for reduced sentences relies on thorough preparation and persuasive argumentation. It requires gathering compelling evidence, consulting expert witnesses if necessary, and crafting a compelling narrative that supports the desired outcome. In some instances, it is the most important part of the representation

Are You Being Investigated for or Charged with Healthcare Fraud?

If you are being charged with healthcare fraud or are involved in a healthcare fraud investigation, the Serafini Law Office can provide you with the best representation possible. Our team will work tirelessly to protect your freedom, rights, and reputation.

Mr. Richard A. Serafini is a defense lawyer who has been practicing law for over 40 years.

He is a former senior prosecutor with the U.S. Department of Justice and supervisor with the U.S. Securities and Exchange Commission. At DOJ he prosecuted some of the largest healthcare fraud cases charged by the United States. With his vast knowledge and experience in investigations and criminal law, he is the person you need to formulate an aggressive strategy to help you achieve the best results.

Our law firm offers representation in criminal defense throughout the United States and particularly in the following cities and states: Miami, Fort Lauderdale, Boca Raton, West Palm Beach, Florida, Pennsylvania, and New York. 

Contact us at (754) 223-4718 for a free consultation.