Nashville Health Care
Fraud Lawyer

The federal healthcare programs of the United States provide valuable services to millions of Americans. Providers routinely bill federal healthcare programs like Medicare and Medicaid when they perform treatments for patients. All healthcare providers who bill federal healthcare programs must be accurate in their billing and follow applicable regulations to the letter. Unfortunately, a few high-profile healthcare fraud cases in Tennessee in recent years have manifested greater scrutiny from the federal government on healthcare providers throughout the Nashville area.

If your practice or business is accused of defrauding any healthcare program, call our firm.It’s essential to know your rights and the value of hiring a Nashville healthcare fraud attorney to represent you. An experienced criminal defense attorney is invaluable when your business faces federal criminal investigation. If your organization is accused of violating the federal False Claims Act (FCA), the penalties are determined on a per-case basis. Sometimes these penalties reach tens of thousands of dollars in fines per case. Whether you made bookkeeping errors or learned that an employee has failed to properly manage your healthcare program reporting processes, McNally Law can help.

A healthcare fraud case can be civil or criminal. While a civil case will typically involve less severe penalties than a criminal case, this does not mean you should assume that a civil case will be easy to manage. Facing any type of investigation for healthcare fraud can be damaging to your business, even if you know you did nothing wrong. The scrutiny of a federal investigation can harm your local reputation. If any intentional missteps did occur, your business could be in jeopardy. The potential consequences of a federal criminal case are even more severe.

No matter what your healthcare fraud case entails, the right attorney can make a significant impact on the outcome of the situation. Attorney Patrick McNally provides aggressive criminal defense in every case accepted by McNally Law. Whether you face a civil claim for healthcare fraud or have become the subject of a federal criminal case, we can help. Our team has years of experience navigating complex fraud cases of all kinds, and we understand what could be at stake when your company is accused of defrauding a federal healthcare program like Medicare, Medicaid, or Tricare. We can provide the criminal defense representation you need so you can continue operating your business with peace of mind.

Healthcare fraud takes many forms, and one or more federal agencies can investigate a healthcare fraud case in Nashville. McNally Law is prepared to defend you against investigations from the various federal agencies that may participate in your case. These agencies include the Department of Defense (DOD), Centers for Medicare and Medicaid Services (CMS), Federal Bureau of Investigation (FBI), the U.S. Attorney’s Office, the Department of Health and Human Services (DHHS), Office of Inspector General (OIG), the Medicare Fraud Strike Force and more.

The majority of healthcare fraud investigations take place at the federal level. If your case involves any federal program and investigators seek criminal charges, your case will unfold through the federal court system, and you face severe penalties if convicted. It’s vital to know the legal standards typically followed in these situations so you can prepare your defense accordingly.

The FCA is legislation aimed at organizations that routinely do business through federal programs. Whenever a business interacts with any services paid for by the U.S. government, the FCA applies and demands strict accuracy and honesty in all reports. Any intentional mischaracterization of a claim for coverage through the federal government is a violation of the FCA and carries severe penalties.

When a government agency pursues any case involving a violation of the FCA at the civil level, the government is likely to seek at least $11,000 in fines per violation, along with treble damages for the losses incurred by the government. If a government agency pursues a criminal case, the potential penalties are even more severe. It’s possible for an individual defendant to face $100,000 in fines at the misdemeanor level and $250,000 at the felony level. For organizations, these penalties increase to $200,000 and $500,000, respectively. It’s important to note that these penalties apply on a per-claim basis. If a defendant is accused of multiple violations, their penalties can easily reach into the millions.

Healthcare fraud can occur in many ways, and these practices can continue for years until they are noticed. Some of the most commonly reported types of healthcare fraud in the U.S. include:

• Double billing entails billing federal programs multiple times for the same services or billing multiple programs for the same services.
• Intentional billing for medically unnecessary services or billing for services not provided, commonly called “phantom billing.”
• Noncompliance with eligibility conditions. Any organization that bills federal programs for healthcare funding must comply with strict regulations to maintain eligibility for billing.
• Incorrect coding, or “upcoding,” practices that essentially over-bill the government for certain services.
• Falsifying patient records. While some such cases pertain to mistakes in recordkeeping, intentionally falsifying patient records to defraud federal healthcare programs is likely to lead to severe criminal charges.
• Prescription drug fraud. This can include dispensing medications to patients without prescriptions, selling prescriptions, and providing medications to patients without medical necessity.

There are several other ways healthcare providers can commit healthcare fraud, all of them potentially leading to severe penalties. Ultimately, whether you intentionally or unintentionally violated your obligations under your contracts with the federal government, it is crucial to seek defense counsel as soon as possible if you become the subject of a healthcare fraud investigation.

Healthcare fraud cases are incredibly complex and often require extensive fact-finding and protracted proceedings no matter what the case entails. You need legal representation from an experienced Nashville healthcare fraud attorney who has the experience and resources necessary to guide you through each stage of your case with confidence. If you are ready to discuss your defense with a reliable legal team, contact McNally Law today and schedule your consultation.