The law firm of Jonas & Driscoll LLP is a prominent defender in criminal health care fraud cases.  The area of health care fraud covers a variety of prosecutions.  For example, the government could allege a violation of the Federal False Claim act in violation of Title 18 U.S.C. 287.  In simple terms, presenting claims to any agency of the United States, knowing the claim is false, fictitious or fraudulent is a criminal violation of

the statute. To prove the  charge at trial the government must present evidence beyond a reasonable doubt that the defendant made and presented a false claim with knowledge the claim was false. Orchestrating the defense in a False Claim Act most often entails an attack on the knowledge element of the offense. The government regulations confronting health care professionals are complex, confusing and sometimes contradictory. This can cause a health care professional to make an error in billing rather than an intentional false claim.       Another statute  relied on by the government in health care fraud prosecutions is violation of Title 42 U.S.C. 1320a-7b(a), which prohibits knowingly and willfully making false statements in billing claims submitted to Medicaid or Medicare.   If the telephone, computer or mail was used  in making the claim, the government may also indict for Violation of the Wire Fraud Statute Title 18 U.S.C. 1342 or the Mail Fraud Statute in violation of Title 18 U.S.C. 1341.

    If a person receives a "kickback" or a referral fee, for referring a person for medial treatment, supplies or medicine, and the intent was to induce  a referral  even if the referral never occurred, it is a criminal violation of the Antikickback statute.   Even if a person or entity had a of multitude reasons justifying a referral fee, if even one purpose of the payment is to induce referrals, it is a violation of the statute. Certain Safe Harbor provisions may be applicable to the defendant's case.  However, often times the Safe Harbor provisions lure a medical professional into believing their conduct is legal when in fact it is illegal.

    Additionally, the government may charge conspiracy  to defraud the United States in violation of Title 18 U.S.C. 371.  Conspiracy requires an agreement between two or more people or entities with a specific intent to commit the criminal objective and an overt act committed by a conspirator or co-conspirator toward that criminal objective. The overt act itself need not be a criminal act.

   Beware the government often uses confidential informants or former employees acting as undercover operatives to record conversations with potential targets of the criminal investigation. It is imperative that defense counsel is retained as early as possible. Defense counsel can conduct a defense internal investigation, inform employees of their rights, arrange additional counsel for those employees in need and conduct in depth interviews while doing a comprehensive review of documents and other evidence that support the billing claims.  Failure to act early and quickly may make the difference between attaining a rejection of all criminal charges as opposed to being "stuck for the long haul".   Prior to making a charging decision generally speaking the prosecution is more receptive to issues of reasonable doubt and other defense claims.