Buffalo Health Care Fraud Attorneys

• The feds can freeze your assets
• You can lose your job, or your business can be shut down
• These are high visibility cases that the media takes a big interest in
• Your reputation may be destroyed
• If convicted, you’ll be forced to pay large sums in restitution and penalties
• You may go to jail

• The feds can freeze your assets
• You can lose your job, or your business can be shut down
• These are high visibility cases that the media takes a big interest in
• Your reputation may be destroyed
• If convicted, you’ll be forced to pay large sums in restitution and penalties
• You may go to jail

Health care fraud is an intentional deception or misrepresentation made by a person or entity with the knowledge that it could result in an unauthorized benefit. Common examples include billing for services not rendered, billing for more expensive services than were provided (‘upcoding’), and paying or receiving kickbacks for patient referrals.

The Anti-Kickback Statute (AKS) is a criminal law that prohibits offering or receiving anything of value to induce or reward patient referrals for items or services paid for by federal healthcare programs. The Stark Law is a civil law that specifically prohibits physicians from referring Medicare or Medicaid patients for certain health services to entities with which they have a financial relationship.

A ‘qui tam’ lawsuit is a type of whistleblower lawsuit filed by a private individual (known as a ‘relator’) on behalf of the government under the False Claims Act. The relator, often a current or former employee, reports that their employer is defrauding the government (e.g., through false Medicare billings). If the lawsuit is successful, the relator is entitled to a percentage of the government’s recovery.

You should not speak to any federal agents or investigators without an attorney present. Politely decline to answer questions and state that you will have your lawyer contact them. Do not destroy any documents. Immediately contact an experienced health care fraud defense attorney to protect your rights and navigate the investigation.

The penalties are severe and can be civil, criminal, and administrative. They include substantial fines, treble damages (three times the amount of the fraud), restitution, potential federal prison time, and exclusion from participating in Medicare, Medicaid, and other federal healthcare programs, which can be a career-ending sanction for a provider.

Upcoding is a common form of billing fraud where a healthcare provider submits a claim using a billing code for a more expensive service or procedure than the one that was actually performed. For example, billing for a comprehensive office visit when only a brief, routine check-up occurred.

While a single, honest mistake is typically not considered fraud, a pattern of improper billing, even if unintentional, can be treated as negligence or reckless disregard and still lead to significant civil penalties. The government does not always need to prove a specific intent to defraud to impose fines and demand repayment.

Yes, hiring an experienced health care fraud defense lawyer is absolutely critical from the moment you learn of an investigation. These are complex, high-stakes cases with the potential for career-ending penalties. An attorney at Friedman & Ranzenhofer will immediately intervene to manage communications with investigators, protect your rights, conduct an internal investigation, and build a strategic defense to achieve the best possible outcome, whether that’s a declination of charges, a favorable civil settlement, or an acquittal at trial.