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What does a recent case say about health care fraud?

The federal Medicare program provides a means for older adults to access health care with fewer worries. Those professionals involved in the health care sector rely on Medicare to cover bills for necessary procedures. The keyword here is “necessary,” since any Florida health care professional that bills Medicare either for work not performed or unnecessary treatments could face fraud charges. The 2021 sentencing of two individuals for health care fraud shows the severe consequences of such crimes.

Health care fraud leads to a harsh sentence

A November 2021 press release from the Department of Justice broadcasts the penalties two men face after their conviction for conspiracy to defraud federal health benefit programs, Medicare and CHAMPVA, the latter being a Veterans Affair’s benefits program. Essentially, the two defendants were found to seek out the elderly to order unnecessary durable medical equipment and a cancer genetic testing physician’s orders.

The guilty verdict shows the consequences of engaging in fraudulent behaviors. The defendants were sentenced to several years in prison, followed by supervised release requirements. The defendants also had to pay a monetary judgment.

The prosecution was able to prove guilt beyond a reasonable doubt, a necessity in a criminal trial. Weaker cases might not be enough to convince a jury, though.

Defending health care fraud

Even with a weak case against them, persons accused of health care fraud may worry about their chances of conviction. A criminal defense strategy may prove there was no intent to commit fraud, as people can make terrible mistakes leading to billing errors.

As long as reasonable doubt exists, a jury may not convict someone. However, when the evidence is strong, a defendant may prefer a plea bargain arrangement. Defense approaches vary based on a case’s particulars.