Experienced And Aggressive Defense Against Health Care Fraud Charges
With the increased focus on the budget deficit and health care, the government is taking a much harder look at money paid out on behalf of Medicare and Medicaid recipients. The federal government has created a multi-agency health care fraud task force in select areas across the country. Detroit is one of those areas.
At the Law Office of John Freeman, we defend health care providers, clinics, durable medical equipment (DME) companies, personal care agencies, and others who provide or bill for medical services. You need skilled, experienced and aggressive legal help if you have been charged with health care fraud:
- Fraudulent billing for services not rendered or equipment not provided
- Fraudulently prescribing drugs or durable medical equipment that is not needed or not provided
- Fraudulent cost reports
- Kickbacks/self-referrals
You may also be facing criminal charges associated with health care fraud, such as:
- Conspiracy
- Mail fraud and wire fraud
- Insurance fraud
- Prescription fraud
- Misuse of Social Security numbers
Before you speak to the police or to a grand jury, contact Detroit healthcare fraud lawyer John Freeman or call us 248-250-9950 for a free initial phone consultation. From offices in Bloomfield Hills, we represent clients in federal and state courts throughout Michigan, from Cheboygan to Detroit, Kalamazoo to Alpena.
Medicare And Medicaid Insurance Fraud Lawyer in Michigan
John Freeman has handled complex white-collar cases like health insurance fraud, first as a prosecutor and now as a criminal defense attorney. As a prosecutor he worked with federal agencies such as the FBI and the IRS to build a case, so he understands how to evaluate the government’s evidence and how to develop effective counter-strategies. He now puts that knowledge to use defending people accused of Medicare and Medicaid insurance fraud.
To help him in the assessment of health care fraud cases, which often include complex financial transactions, Mr. Freeman can draw upon a network of forensic accountants, computer experts and other professionals. These specialists can be critical to your defense and can provide persuasive testimony in court.
Hesitation Can Harm Your Defense
Often, healthcare fraud cases begin as a civil matter or a whistleblower complaint from a disgruntled employee, an unhappy patient, or a vindictive family member. An investigation may begin with a Medicare or Medicaid audit or a grand jury may be called and you may be subpoenaed to appear.
If you believe you are under investigation or have been asked to appear before a grand jury or law enforcement, talk to a criminal defense lawyer as soon as possible. The Law Office of John Freeman can evaluate your case and advise you on your best legal defense options.
What Is Healthcare Fraud?
Healthcare fraud involves Medicare, Medicaid, private insurance, and other healthcare programs. Federal law defines it as knowingly and willfully executing or attempting to execute a scheme to defraud a healthcare benefit program. It also includes obtaining money or property by false pretenses in connection with healthcare. The government doesn’t need to prove you were successful—only that you knowingly attempted to commit fraud. Violations can trigger both civil penalties and criminal charges.
Healthcare fraud cases are document-heavy and data-driven. Prosecutors rely on everything from billing records and patient charts to testimony from former employees and business partners to build a case. Federal agents often spend months or years investigating before making a case public.
As a healthcare provider or business owner, you might not even realize that certain billing practices are considered fraudulent until you’re contacted by investigators. Sometimes what the government sees as a scheme to defraud is actually the result of coding errors or business practices that were never intended to be deceptive.
Statistics and Enforcement Trends
Healthcare fraud enforcement is one of the Justice Department’s top priorities. Federal task forces in Detroit and other major cities routinely announce large investigations and indictments targeting healthcare providers, including clinics, home health agencies, and pharmacies. The Detroit task force’s existence means that providers across Michigan are more likely to face scrutiny, even if the alleged misconduct is relatively minor.
According to the United States Sentencing Commission, healthcare fraud offenses have increased 19.7% since fiscal year 2020. Nearly 20% of healthcare fraud cases involved losses over $9,500,000, while the median loss was $2,532,314.
Depending on the exact charges involved, a conviction could result in decades in prison—and if aggravating factors are present, that likelihood goes up. The U.S. Sentencing Commission reports that the most common aggravating factors included:
- Losses over $1 million
- Using “sophisticated means” to carry out or hide the crime
- The number of victims and/or the extent of harm they suffered
- Abusing a public position of trust
- Obstructing justice
Federal prosecutors have an extremely high conviction rate, and the punishments are often more severe than for state crimes. Having an experienced healthcare fraud defense lawyer like John Freeman on your side is the best way to protect your rights and reduce the potential consequences. The Law Office of John Freeman can use our network of professional experts to independently investigate and fight back from the moment you know you’re a person of interest.
Potential Penalties for Healthcare Fraud
The consequences of a federal healthcare fraud conviction depend on the exact charges. The punishments for violating the federal healthcare fraud statute are severe: you could face up to 10 years in prison for each count and fines up to $250,000. Financial penalties often include restitution, forfeiture of assets, and exclusion from Medicare or Medicaid programs.
In addition to criminal penalties, civil liability under the False Claims Act can result in treble damages (three times the amount of the government’s loss), plus up to $250,000 and five years in prison for each false claim submitted.
- Common Defenses to Healthcare Fraud Charges
Every healthcare fraud case is different. The right defense depends on the facts and the statutes you’re accused of violating. Some common strategies include:
- Lack of intent: The government has to prove you acted knowingly and willfully to obtain unearned benefits. Honest billing errors or confusion from complicated regulations don’t meet the definition of intentional criminal fraud.
- Medical necessity: Services or prescriptions the government says are unnecessary may in fact have been appropriate, based on your professional judgment. Expert testimony can support their legitimacy.
- Insufficient evidence: Prosecutors often rely on large amounts of billing data—but patterns alone don’t prove that you knowingly intended to commit fraud. The Law Office of John Freeman can challenge whether the evidence truly connects you to a fraudulent scheme.
- Entrapment or government overreach: In some cases, investigators pushed too far, or undercover operations went beyond the law. Your defense may include entrapment allegations (you were coerced into doing something you might not normally do) or arguing that you’re a victim of government overreach.
The key is to challenge the government’s story by presenting a compelling, fact-based defense.
Discuss Your Case With A Skilled And Experienced Attorney
For a free initial phone consultation with the Law Office of John Freeman, call 248-250-9950 or send us an e-mail.