Top Wilmington, DE Health Care Fraud Lawyers Near You

Health Care Fraud Lawyers | Wilmington Office

123 S Justison Street, Suite 100, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

222 Delaware Ave, Suite 1410, Wilmington, DE 19801-1621

Health Care Fraud Lawyers | Wilmington Office

Nemours Building, 1007 N. Orange Street, Suite 600, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

1007 N Orange Street, 4th Floor, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

1201 N Market St, Suite 1400, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

500 Delaware Avenue, Suite 1410, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

300 Delaware Ave, Suite 1015, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

824 N. Market Street, Suite 710, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

1201 N Market St, Suite 1406, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

500 Delaware Avenue, Suite 200, PO Box 32, Wilmington, DE 19899

Health Care Fraud Lawyers | Wilmington Office

704 King Street, Suite 500, PO Box 1031, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

1201-A King Street, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

405 North King Street, Suite 500, Wilmington, DE 19801-3700

Health Care Fraud Lawyers | Wilmington Office

919 North Market Street, Suite 1300, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

300 Delaware Ave, Suite 210, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

Renaissance Centre, 405 N. King Street, 8th Flr., Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

600 N. King Street, Suite 800, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

1201 North Market Street, Suite 1001, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

919 N. Market Street, Suite 300, PO Box 2323, Wilmington, DE 19899

Health Care Fraud Lawyers | Wilmington Office

1000 N. West St, Ste 1200, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

1105 North Market Street, Suite 600, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

1201 North Market Street, Suite 2100, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

222 Delaware Ave, Suite 1600, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

919 North Market Street, Suite 1000, Wilmington, DE 19801

Health Care Fraud Lawyers | Wilmington Office

1201 King Street, Suite B, Wilmington, DE 19801

Wilmington Health Care Fraud Information

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Lead Counsel Verified Attorneys In Wilmington

Lead Counsel independently verifies Health Care Fraud attorneys in Wilmington and checks their standing with Delaware bar associations.

Our Verification Process and Criteria
  • Ample Experience Attorneys must meet stringent qualifications and prove they practice in the area of law they’re verified in.
  • Good Standing Be in good standing with their bar associations and maintain a clean disciplinary record.
  • Annual Review Submit to an annual review to retain their Lead Counsel Verified status.
  • Client Commitment Pledge to follow the highest quality client service and ethical standards.

Find a Health Care Fraud Attorney near Wilmington

The Average Total Federal Prison Sentence for Health Care Fraud in Delaware

36.53 months*

* based on 2019 Individual Offenders - Federal Court sentencing in Delaware federal courts. See Sentencing Data Information for complete details.

What Qualifies as Health Care Fraud?

Health care fraud involves making false representations to gain money or benefits related to medical care, insurance, or government benefits. Health care fraud can be committed by anyone involved in the healthcare industry, including patients, doctors, insurance providers, and medical services companies.

State and federal law enforcement take health care fraud very seriously. The penalties can include years in prison for a felony conviction. However, some innocent people are caught up in false accusations of fraud and should consult with a criminal defense lawyer to understand their legal rights.

What Are the Types of Health Care Fraud?

There are several types of health care fraud. In some cases, fraud is committed by a prospective patient, including false statements on an insurance form. This could include using someone else’s insurance to get medical care.

More extensive healthcare fraud involves health care providers or medical services businesses. Medical providers and home health services may make a fraudulent claim to patients, insurance companies, or Medicare for compensation. Some examples of health care fraud may include:

  • Unbundling, or charging separate billing codes for bundled services
  • Double-billing or duplicate billing
  • Billing for services that were never provided
  • Fraudulent billing for medically unnecessary services
  • Up-coding, or seeking reimbursement for services that should be billed at a lower rate
  • Misrepresentation of the type of service provided

Kickback Fraud

Another type of fraud in health care involves kickbacks. Kickbacks are the referral fees, illegal remunerations, bribes, or rebates paid directly or indirectly for referrals in health care. Kickbacks are illegal in health care under the Anti-Kickback Statute. It is unlawful to pay for inducing or rewarding patient referrals for business involving any item or service payable by the federal healthcare programs, including drugs, supplies, or health care services.

Self-Referral Fraud

Physician self-referral laws prohibit physicians from referring patients with Medicare or Medicaid to facilities or services where the physician has a financial interest. This includes entities where the doctor’s immediate family member has a financial relationship. For example, if a doctor’s spouse is a co-owner of a radiology provider, the doctor cannot refer a patient to that provider, unless an exception applies.

Is Healthcare Fraud a Felony?

Health care fraud can be charged as a misdemeanor or a felony. As a misdemeanor, a conviction could carry up to one year in jail and a fine. As a felony, health care fraud is punishable by more than a year in prison and thousands of dollars in fines.

The penalties associated with health care fraud depend on the specific facts involved. Some aggravating factors can increase the penalties, including where the fraud involved:

  • Multiple incidents of fraud
  • Medical identity theft
  • Insurance fraud
  • Money laundering

Is Healthcare Fraud a Federal Crime?

Health care fraud can be a state-level crime in Delaware or a federal offense, depending on the circumstances. It is federal crime for whoever knowingly and willfully executes a scheme to:

  • Defraud any health care benefit program; or
  • Obtain money, property, or health care benefits by fraudulent pretenses, representations, or promises.

The penalties for a federal government fraud conviction include up to 20 years in prison. If the fraud results in death, a conviction could result in life in prison.

How is Health Care Fraud Detected?

Healthcare fraud can be detected through computerized fraud prevention systems or reporting of potential fraud. The Centers for Medicare and Medicaid Services (CMS) uses a Fraud Prevention System (FPS) to analyze healthcare providers networks to detect patterns that represent a risk of fraudulent activity. The leads are then investigated by field office agents to identify possible fraud and refer the health care fraud cases for criminal prosecution.

Why Do I Need a Healthcare Fraud Defense Lawyer?

There are severe penalties for a conviction of health care fraud. A felony conviction could result in a permanent criminal record, and make it more difficult for you to find a job in the future. With a lot at stake, a criminal defense lawyer can help you fight the charges for health care fraud to avoid a criminal record. An experienced criminal defense attorney can also negotiate to get a plea deal with reduced criminal charges or minimum sentencing.

If you are accused of health care fraud, you may have several legal defense options. The prosecutor has the burden of proving every element of the offense beyond a reasonable doubt. Possible criminal defenses to fraud charges include:

  • No intent to commit fraud
  • False claims were made by mistake
  • Another person was responsible for making a false claim
  • Incorrect claims were caused by computer error or operator error

Health care fraud may also include related charges, which could increase the penalties and consequences of a conviction. Some related charges to health care fraud may include forgery, insurance fraud, or identity theft.

How an Attorney Can Help

An attorney can often resolve your particular legal issue faster and better than trying to do it alone. A lawyer can help you navigate the legal system, while avoiding costly mistakes or procedural errors. You should seek out an attorney whose practice focuses on the area of law most relevant to your issue.

What to Expect from an Initial Consultation

  • Seek to determine whether the attorney can represent you. There is no one-size-fits-all legal solution and it may turn out your needs are better served by an attorney in a different specialization.
  • It’s important to find a legal ally who is both competent in the law and someone you can trust to protect your interests.
  • Discuss how the practice’s billing works and discuss possible additional charges or fees that may arise during or after the resolution of your case.

An attorney consultation should provide you with enough information so that you can make an informed decision on whether to proceed with legal help.

How will an attorney charge me?

A reputable attorney will be very upfront about how he/she will charge you. The three most common fee structures that attorneys use to charge for their services are:

  • Bill by the hour
  • Contingent fee agreement
  • Flat fee agreement

Depending on your specific legal situation, it’s possible that only one type of fee structure is available. For instance, criminal defense attorneys almost always bill by the hour. In a flat fee arrangement, an attorney accepts a one-time payment to help you resolve your issue. With a contingent fee agreement, the client pays little to nothing upfront and the attorney receives a percentage of the money recovered if you win your case.

Common legal terms explained

Plaintiff – a person or party who brings a lawsuit against another person(s) or party/parties in a court of law. Private persons or parties can only file suit in civil court.

Judgment – A decision of the court. Also known as a decree or order. Judgments handed down by the court are usually binding on the parties before the court.

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