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DOJ charges 2 men with Medicare fraud

| Jan 12, 2021 | Firm News |

Few crimes carry as damaging a stigma as Medicare fraud. In New York, federal authorities recently revealed charges against two men who face significant penalties in federal court for defrauding the Medicare system.

In a release from the Department Of Justice’s website, the two men stand accused of taking advantage of recent changes intended to loosen restrictions to defraud Medicare of $30 Million. This case brings up important questions for pharmacists and other healthcare workers in Georgia at risk for similar charges.

What is healthcare and Medicare fraud?

Healthcare fraud and Medicare fraud are related in that the crimes themselves tend to be relatively similar. A person intends to profit from false claims submitted to either the insurer or Medicaid in both instances.

There are few common ways this happens, and in the case of the two men charged above, they used the practice of “upcoding.” Upcoding is the misuse codes on documents submitted to insurers for reimbursement of more expensive versions of drugs provided to patients.

What are the possible defenses?

As with any criminal charge, there are several possible defenses. It is possible to face such charges after an honest mistake or after a miscommunication with another member of the care team.

A skilled defense attorney, however, wouldn’t stop simply at waging a specific defense. They would challenge every part of the prosecution’s case: evidence, investigations, and investigators’ conduct. By holding the entire investigation accountable, it is possible to challenge the basis for a charge.

What is the penalty?

In a federal case, and any case, really, it comes down to the charges filed. Here, the two defendants face different charges, ranging penalties from two to 20 years of imprisonment and significant fines.

The seriousness of federal fraud charges

Facing federal charges means facing federal attorneys, time in federal prison. Charges like this are complicated and devastating. If you find yourself under investigation for any federal white-collar crime, it is vital to ensure your rights by reaching out to a skilled attorney familiar with the federal court system.