Understanding the Need for a Healthcare Fraud Attorney

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The regulations and laws prohibiting healthcare fraud are complex and specific. This implies that if you have been charged with some kind of healthcare fraud, you could be penalized under several different federal statutes.

Forbes reported, as of 2015, in the United States, there were over 67,000 pharmacies. One kind of prescription fraud happens when a pharmacy sends out automatically prescription refills even before any patient requests refills. The pharmacies would be inflating their revenue by charging for even those prescriptions that were not being used by the patients. We understand that Medicaid, Medicare, and private insurance organizations could be losing huge sums of money to this malpractice. Often people and organizations are accused or convicted for things that they have not done.

The healthcare fraud attorney comes into the picture then to defend the accused against the false allegations. Moreover, every business must realize the importance of the role played by a healthcare fraud defense lawyer. He would be defending clients from various sectors of the healthcare industry and that may include:

  • Individual nurses, doctors, pharmacists
  • Clinics, hospitals, and hospital systems
  • Home health care organizations
  • Medical billing & coding firms

Various Healthcare Fraud Charges to Defend

A healthcare fraud solicitor would be defending a broad spectrum of charges relating to healthcare fraud. The government is pretty aggressive regarding healthcare fraud and grand jury investigations could take place.

Whether you have already been indicted or you are still under investigation, an experienced attorney would be making all the difference. He would be having sound knowledge of different types of healthcare fraud charges and ways to tackle them.

  • Medicaid and Medicare fraud that involves products and services.

  • Medicare or Medicaid services’ fraudulent billing.

  • Violations related to the code of ethics.

  • Writing fraudulent prescriptions.

  • Running illegitimate Internet or online pharmacies.

  • Illegal exporting and importing of drugs that is FDA-regulated.

  • Bribery cases relating to the medical boards.

  • Lying on precisely the licensing applications.

  • Self-referrals & kickbacks.

Healthcare Fraud Claims

The most common kinds of healthcare or medical fraud claims would be involving all these government programs:

  • Medicare is supposed to be a complete federal healthcare program that provides insurance, as well as, healthcare services to persons who are aged 65 and above, and also those people with certain kinds of disabilities and illnesses.
  • Medicaid is supposed to be a joint federal-state healthcare program that provides need-based healthcare and insurance services to individuals belonging to low-income groups including the disabled, blind, and the aged.

Are You Having a Good Healthcare or Medical Fraud Case?

The first thing an attorney would be making sure is that you have a valid case. He would be determining if the case is good and has well-documented evidence of Medicaid fraud or Medicare fraud or even Tricare fraud. Good fraud cases would be having certain whistleblowers with independent and direct knowledge of the specific fraudulent activity. These are the insiders who comprise contractors, employees, agents, or even industry experts.


If you choose the perfect healthcare fraud lawyer for defending your case, he would easily identify and fully understand all the different schemes that are utilized for defrauding the healthcare system. He would have the necessary experience and knowledge to help you win the case.