Columbus Health Care Fraud Attorney Near You
Health Care Fraud Lawyers Near You in Columbus, Ohio Assisting Health Providers & Practices Facing Criminal Charges
If you, your organization, or your company has been charged with committing health care fraud, it is essential that you have an experienced team of heath care fraud lawyers near you on your side during your entire criminal case.
Whenever a person or entity intentionally gives false information to get health care benefits unfairly, this act constitutes health care fraud. If you, your organization, or your company has been charged with committing this offense, it is essential that you have a health care fraud lawyer on your side during your entire criminal case.
Ohio comprises many individuals who depend on government programs for federal health care benefits. Given this group of dependent individuals, the Medicare Fraud Strike Force directly monitors the state. The Strike Force is composed of various components, including teams of investigators and prosecutors who represent several federal agencies. Those agencies include the Department of Health and Human Services (DHHS), the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), and the Office of the Inspector General (OIG).
Due to the people who regularly depend on public programs for health care, the Strike Force carefully watches the claims individuals file in the Columbus area to ensure false claims are not being paid out. The Strike Force then has the authority to investigate these claims and prosecute individuals, companies, and other entities that allegedly commit health care fraud.
The penalties for these convictions can be devastating. You could be looking at years in jail or prison, high fines, and a damaged reputation. Grappling with these possibilities while going up against the Strike Force is daunting, to say the least. However, when you have a Columbus health care fraud attorney with Joslyn Law Firm fighting for you, you can rest a little easier and know what to expect.
Our firm can protect your rights, speak to the Strike Force and other involved parties on your behalf, and create a defense strategy that clears your name. Your only job is to focus on yourself.
We Have Over 50 Years of Collective Experience Fighting for Ohio Clients Like You
The team at Joslyn Law Firm has defended over 20,000 cases, representing clients from all backgrounds: celebrities, blue-collar workers, attorneys, students, and even professional athletes. We have taken a unique, personalized approach with each of them to ensure their defense strategy reflects the details of their case and get their charges reduced or dropped.
When it comes to health care fraud cases, common defenses we apply include:
- Lack of intent
- Lack of evidence
- Consent
- Entrapment
- Mistaken identity
Treating each client like an individual rather than a dollar sign has helped us win notable honors, such as Top 10 Attorneys in the American Jurist Institute and the Top 10 Trial Lawyers from the National Trial Lawyers.
These are just two of our many achievements. The Columbus health care fraud attorneys near you at Joslyn Law Firm are ready to represent you throughout every stage of your criminal case and help you pursue the best result available in your circumstances. Please give us a call today at (614) 444-1900 or contact us online to learn more about how we could assist you with defending against your criminal health care fraud charge.
What Is Health Care Fraud in Columbus, OH?
Health care fraud occurs when an individual or company intentionally provides false information to wrongfully receive health care benefits. Medicaid fraud is a state offense, while federal law covers fraud against Tricare fraud, Medicare fraud, federal workers’ compensation fraud, or some other health care program that is administered by and through the federal government. In order to be charged with and/or convicted of federal health care fraud in Ohio, you must have done one or more of the following:
- Violated the Stark Law – The Stark Law is also sometimes called the Self-Referral Law. This federal statute prevents doctors (as well as individuals who are immediate family members of a doctor) from sending one or more of their patients, via referral, to a health care service, in cases where the doctor has an investment interest – or an ownership interest – in that entity. The same holds true if the doctor and the entity have some sort of compensation arrangement in place.
- Violated the Anti-Kickback Statute – Under federal law, health care providers are strictly prohibited from obtaining some sort of financial kickback, stipend, or fee, in exchange for a patient referral. This law applies not only to doctors but also to business owners and marketing representatives.
- Engaged in Prescription Fraud – When a doctor and/or a health care practice issues an unusually high number of narcotic prescriptions (i.e., running a “pill mill”), the federal government can begin to investigate the doctor and his or her medical practice for insurance fraud.
- Violated the Medicare False Claims Act – Submitting a false or inaccurate claim to a health care program run by the federal government, such as Medicare, can cause the government to begin a formal investigation into a medical office’s billing practices. This is a type of Medicare fraud.
- Engaged in Billing Fraud – The federal government is especially vigilant when it comes to investigating billing practices that involve “upcoding” – or utilizing a code that is billed higher than the code for the service that was performed. The government also regularly investigates practices that bill for ghost patients – or patients who do not actually exist – as well as instances of phantom billing (or billing for one or more services that were not actually provided). The government also investigates instances in which a medical provider or practice bills for medical services or equipment that were not actually necessary to provide the patient with medical treatment.
- Errors in Certification – The federal government has the authority to investigate instances of fraudulent certification for home hospice care and other types of home health services.
No matter what law you are accused of violating, you should speak with a Columbus health care fraud lawyer as soon as possible.
No matter what law you are accused of violating, you should speak with a Columbus health care fraud lawyer as soon as possible. Contact us here.
Penalties – Will I Go to Jail for a Health Care Fraud Conviction?
Health care fraud can result in serious penalties, including possible jail time, depending largely on the circumstances that are involved. If you are charged under Ohio law, you could face the following charges and jail time:
- If the fraud is worth $1,000 to $7,500 = Fifth-degree felony charges and up to 12 months in jail.
- If the fraud is worth $7,500 to $150,000 = Fourth-degree felony charges and up to 18 months in prison.
- If the fraud is worth more than $150,000 = Third-degree felony charges and up to five years in prison.
Federal charges can result in more severe penalties according to the federal sentencing guidelines, which include possible time in federal prison.
Specialized federal agents build federal cases against you with sophisticated methods. If you are being investigated or prosecuted by the federal government, you need an experienced federal criminal defense attorney. Joslyn Law Firm vigorously defends people who have been charged with federal health care fraud in Central Ohio.
If you are sued civilly, and a civil penalty is imposed, you might have to repay the claim, or a federal health care program could elect to exclude you or your business. The Ohio Medical Board can also call you to testify, and as a result, you may lose your license to practice medicine or your hospital privileges at one or more medical facilities.
Defenses for Columbus Health Care Fraud Charges in Columbus, Ohio
When our Columbus medical fraud attorney reviews your case, they can begin to craft a defense strategy that accounts for your side of the story and ultimately seeks to reduce your charges and bail and/or drop the case altogether.
Despite every case differing, our team has seen a lot of the same themes across health care fraud cases. What we’ve learned has helped us narrow down some of the most effective defenses for such cases. Depending on the circumstances of your situation, we may base our strategy on:
- Entrapment: A law enforcement officer could have threatened, coerced, or harassed you into committing health care fraud. Otherwise, you wouldn’t have done it.
- Lack of evidence: The prosecution lacks sufficient evidence (e.g., witness statements and government documents) to prove you committed health care fraud beyond a reasonable doubt.
- Lack of intent: The statute says to be charged and convicted of health care fraud, you must have intended to do so. If you clearly made a mistake or didn’t intend to commit this offense, you may be free to go.
- Consent: If the alleged victim of the crime gave you the “OK” to act on their behalf as opposed to intentionally pretending to be them, we can present evidence that you had permission and did not commit fraud.
- Mistaken identity: Someone else could have pretended to be you when they allegedly committed health care fraud. Alternatively, the plaintiff could have “gotten the wrong guy” and misidentified you as the culprit.
These are just a handful of the defenses we may apply to your case. For some clients, we can use more than one.
Evidence in Columbus Health Care Fraud Cases
The prosecution must prove you willingly and intentionally committed health care fraud beyond a reasonable doubt. In doing so, they may present evidence, such as:
- Related federal or state documents
- Claims for the benefits programs
- Your financial records
- Emails
- Text messages
- Tax forms
- Medical records
- Social media
- Wiretaps
- Eyewitness and expert witness statements
They can use the communications to tell a story about how you conspired with your colleagues or others involved to commit health care fraud. On top of that, they might manipulate your financial records to show you have a history of lying on government documents for your own benefit.
In any case, one of our health care fraud attorneys in Columbus can go to bat for you. We will study the prosecution’s evidence and identify the gaps in their story. From there, we can cross-examine witnesses and bring in our own, as well as refute the prosecution’s evidence.
Our team of medical fraud attorneys near you will exhaust every resource so we can secure a favorable outcome and keep you out of jail.
Resources for Health Care Fraud in Ohio
Medicaid Fraud Control Units (MFCUs): Created by the Social Security Administration (SSA), officials in this government agency investigate and prosecute those who allegedly commit fraud, abuse, and neglect against residents in health care facilities. Each state’s Attorney General’s office manages the MFCU and hires a team of independent attorneys, auditors, and investigators to carry out these operations.
Healthcare Fraud Prevention Partnership (HFPP): This organization helps detect and prevent health care fraud. It teams up with law enforcement, federal and state agencies, and private health insurance plans to offer insight, innovation, and impact to reduce fraud and financial harm.
National Health Care Anti-Fraud Association (NHCAA): Several private health insurance companies, as well as state and federal agents, founded the NHCCA in 1985 to protect citizens from health care fraud. Today, it’s leading this fight with over 90 private health companies. Preventing fraud isn’t its only mission, as it also offers resources and education about combatting it.
Central Ohio Association of Certified Fraud Examiners (COACFE): Founded in 1992, 160 members of the COACFE work to end fraud in multiple industries, such as government, education, finance, insurance, and security. In doing so, it provides anti-fraud training, sets high eligibility standards for CFE admission, and offers leadership to convey its professionalism and integrity,
AARP Fraud Watch Network | Resilience, Strength and Time (ReST) program: Being a victim of fraud can be devastating. Thankfully, you’re not alone, and emotional support is available. A trained facilitator will lead an hour-long support group that will help you rebuild your trust and resilience after this terrible experience. These meetings are confidential, and they’re available every day. You can join many as you’d like.
Ohio Health Care Fraud Cases
United States vs. Bernard Oppong
Darrell Bryant and Gifty Kusi owned and ran Health and Wellness Medical Center, LLC (HWMC) and Health and Wellness Pharmacy, LLC (HWP) in Ohio. Neither of them was a medical doctor. One part of HWP’s business was to sell compound creams that would help treat various health issues. Bryant and Kusi broke the law by dispensing them in batches rather than creating them per the patient’s individual needs.
Dr. Bernard Oppong, a medical doctor, worked at HWMC and was one of the most frequent prescribers of these creams. He also didn’t have a professional relationship with the majority of the patients.
He ended up prescribing more than $500,000 worth of prescriptions, most of which were under CareSource, which is a Medicaid organization.
Kusi and Bryant also requested the physicians at HWMC to pre-sign blank and incomplete prescriptions for the Schedule III drug, Suboxone, and place them in patients’ charts. Oppong obliged and even signed off on Bryant’s “patients,” who knew him as “Dr. Bryant.”
After law enforcement conducted an investigation for suspected fraud in July 2015 and September 2016, Oppong was charged with:
- One count of conspiracy to commit health care fraud
- One count of health care fraud
- Four counts of making false health care statements
- One count of conspiracy to illegally distribute controlled substances
Oppong was convicted of five counts, including conspiracy to illegally distribute controlled substances, health care fraud, and making false health care statements.
United States vs. Delores Knight
Delores Knight ran Just Like Familee (Familee), a home-health service business, for about 10 years. Her daughter Theresa Adams co-owned the business and was in charge of sales and marketing. Her son Isaac Knight was in charge of the Mentor, Ohio, branch office.
The business committed health care fraud from 2007 to 2014 by:
- Claiming false compliance with Medicaid, Medicare, and the Department of Veterans Affairs (VA)
- Billing for services they did not provide
- Billing various insurers and agencies for one service
Medicare, Medicaid, and the VA eventually prohibited Familee from billing them. This prompted the family to open a new business, Elegance Home Care, and apply for accreditation with Medicare again.
Delores and Isaac Knight were then indicted by a jury for:
- Money laundering
- Health care fraud
- Conspiracy to commit health care fraud
Isaac Knight was also indicted for lying on his accreditation application with Medicare.
The mother and son were convicted on all counts, with Delores serving a 120-month prison sentence and Isaac 87 months, in addition to an $8,168,107.24 restitution fine. Both filed appeals, but the appeals court affirmed their sentences.
Ohio Health Care Fraud News Stories
Ohio Home Health Care Provider Agrees to Pay $500,000 As Part Of False Claims Act Settlement
January 4, 2022
From 2014 to 2017, a Dayton home health care provider, Academy Health Care Services, billed for individual services when they only provided services in group settings. The nurses didn’t even spend enough time with individual patients to get paid for such services.
As a result, Ohio Medicaid paid more reimbursement than the services and settings the organization provided. These offenses meant that Academy Health Care Services violated the False Claims Act.
The penalties include $500,000, half of it accounting for restitution. In addition, it was ordered not to provide health care services for beneficiaries starting on December 31, 2021, and to shut down entirely by June 30, 2022.
Columbus Couple Agree to Plead Guilty to Health Care Fraud Scheme That Targeted City Employees, First Responders, Military Health Benefit Provider
February 27, 2019
An engaged couple, Amy Kirk and Ryan Edney, pleaded guilty to conspiring to commit health care fraud. Kirk worked as a nurse practitioner at Pain Management Consortium of Ohio (PMCO), while Edney was the president of RX Health Solutions, LLC.
From 2014 to 2017, the two conspired to commit health care fraud against Medicaid and other health insurance providers by prescribing and billing medicinal creams that were medically unnecessary. Kirk would even order prescriptions for false medical conditions. Sometimes, the defendants never met or examined the patient and would still prescribe the medications.
When they did meet patients, they would falsify their information and often recruit them for these creams and wellness pills. A lot of them were city employees, like law enforcement officers, teachers, and firefighters, as the government was more likely to pay for these creams.
The couple ended up filing over $750,000 in claims and received kickbacks of upwards of $350,000 for themselves. Part of their punishment includes paying the $750,000 for restitution. According to The Columbus Dispatch, Kirk was sentenced to six months of home confinement and five years of probation. Edney also received a probation sentence.
Frequently Asked Questions on Health Care Fraud Cases
Do I Need a Medical Fraud Lawyer Near Me to Help Me With My Ohio Health Care Fraud Case?
There is no legal requirement to hire a lawyer. However, an attorney knows the ins and outs of the legal system, so you could greatly benefit from one. They may offer you the following services:
- Keeping you in the loop throughout your case
- Communicating with the courts, prosecution, law enforcement, and others involved in your case
- Working to have the prosecution reduce or drop your charges
- Trying to reduce your bail
- Gather and analyze evidence
- Negotiating a plea deal
- Establishing which laws apply to your case
- Representing you throughout all legal proceedings
What Are Examples of Health Care Fraud?
Health care fraud may look like:
- Billing health insurance companies for services and treatments patients didn’t receive
- Falsifying patient records and insurance claims
- Prescribing unnecessary medicines
- Ordering unnecessary diagnostic tests
- Prescribing medications to patients with whom you don’t have a professional relationship
- Misrepresenting dates, locations, and times of services
- Giving kickbacks on referrals
What Defenses Can a Medical Fraud Attorney Use in My Health Care Fraud Case?
Common defenses in a health care fraud case include:
- Entrapment
- Mistaken identity
- Lack of evidence
- Lack of intent
- Consent
Your attorney might use a mix of these defenses depending on the details of your case.
What Are Penalties for Health Care Fraud in Columbus, Ohio?
If you’re convicted of health care fraud, you may face high fines and jail or prison time. You could also lose your medical license. On top of the detrimental effects on your professional and financial well-being, you may lose your right to vote or driving privileges.
What’s the Difference Between Health Care Fraud and Abuse?
Health care fraud is when one intentionally misrepresents or falsifies services. On the other hand, health care abuse is when one fails to administer proper medical procedures.
Our Columbus Health Care Fraud Attorneys Near You Can Defend Against Your Charges
For the federal government to obtain a criminal conviction against you for federal health care fraud, it has a high legal burden to overcome.
Specifically, the government has the burden of demonstrating beyond a reasonable doubt that you intended to commit health care fraud. With the constantly changing health care laws in the industry, mistakes, and human error – rather than a specific intent to defraud the federal government – can account for many instances of alleged health care fraud.
Even though mistakes must be corrected promptly, mistakes are not criminal in nature and should not be deemed as such. If you or your business is facing health care fraud charges, a Columbus health care fraud attorney from our firm can review your circumstances and help you come up with one or more legal defenses that you could argue in court.
Speak With a Columbus Health Care Fraud Lawyer Near You at Our Firm Today
If you or your practice is facing a criminal charge for health care fraud (including Medicare fraud), the white-collar legal team at Joslyn Law Firm is ready to help in all Central Ohio Counties including Union County, Delaware County, Licking County, Fairfield County, Pickaway County, Madison County, and Franklin County Ohio.
To schedule a free case evaluation and legal consultation with a Columbus health care fraud attorney, please call us at (614) 444-1900 or contact us online to learn more about how we could assist you with your legal defense.
Additional Criminal Fraud Defense
We also provide defense lawyers for these other types of fraud in Columbus and central Ohio:
