Top Cheyenne, WY Health Care Fraud Lawyers Near You

Health Care Fraud Lawyers | Cheyenne Office

2515 Warren Ave, Suite 450, Cheyenne, WY 82003

Cheyenne Health Care Fraud Information

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Find a Health Care Fraud Attorney near Cheyenne

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

29.55 months*

* based on 2019 Individual Offenders - Federal Court sentencing in Wyoming 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 Wyoming 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.

When to Hire a Lawyer

It is in your best interest to get legal help early on in addressing your situation. There are times when hiring a lawyer quickly is critical to your case, such as if you are charged with a crime. It may also be in your best interest to have a lawyer review the fine print before signing legal documents. A lawyer can also help you get the compensation you deserve if you’ve suffered a serious injury. For issues where money or property is at stake, having a lawyer guide you through the complexities of the legal system can save you time, hassle, and possibly a lot of grief in the long run.

Tips on Approaching an Initial Attorney Consultation

  • Use the consultation as a means of gaining a better understanding of your legal situation.
  • Ask the attorney how many cases similar to yours he/she has handled. An attorney’s experience and knowledge can speak to their expertise (or lack of) in addressing your situation.
  • Your attorney should be able to articulate roughly how long a case like yours will take to resolve and what sort of procedures to expect.
  • Determine how comfortable you are working with the lawyer and/or law firm.

How to Find the Right Attorney

  • Determine the area of law that relates to your issue. Attorneys specialize in specific practice areas around legal issues within the broad field of law.
  • Seek out recommendations from friends, family, and colleagues. A successful attorney or practice will typically have many satisfied clients.
  • Set up consultation appointments to get a better understanding of your case as well as gauge your comfort level with different attorneys. Find the attorney who is the right fit for your needs.

Common legal terms explained

Personal jurisdiction – Requirement that a particular court have authority over a person, in order to bind that person to the judgment of the court, based on minimum contacts. International Shoe Co v. Washington is a landmark Supreme Court case outlining the scope of a state court’s reach in personal jurisdiction.

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