Navigating Healthcare Fraud Defense with Ronald W. Chapman II

Learn How Ron Delivered “The largest loss for the Eastern District of Michigan in more than a decade” - Detroit Free Press

In an era where the integrity of healthcare services is under intense scrutiny, facing charges of healthcare fraud can have profound implications on your professional and personal life. Ronald W. Chapman II stands as a pillar of defense for those accused, blending unparalleled experience with a deep understanding of healthcare regulations, Ron has achieved the largest healthcare fraud defense verdicts in the United States and has achieved a record number of recent federal acquittals.

RESULTS

Blog

Results

Kentucky Interventional Pain Physician Acquitted of Federal Charges

Results

Nursing Home Administrator Acquitted of Bizarre Health Care Fraud Allegations

Results

KY Physician Fully Acquitted of All Federal Charges

Results

Nationally Renowned Rheumatologist Cleared of Healthcare Fraud

Results

Health Care Fraud Statutes

The Federal government charges health care fraud in a variety of ways. A skilled health care fraud lawyer will be familiar with these statutes and the caselaw associated with them:

Healthcare Fraud - 18 U.S.C. § 1347: This statute makes it a federal crime to knowingly and willfully execute, or attempt to execute, a scheme to defraud any healthcare benefit program or to obtain, by means of false or fraudulent pretenses, any money or property owned by, or under the custody of, any healthcare benefit program. The penalties for violating this statute include a fine, imprisonment up to 10 years, or both. If the violation results in serious bodily injury, the imprisonment can be up to 20 years, and if the violation results in death, the violator can be sentenced to life imprisonment.
False Statements Relating to Healthcare Matters - 18 U.S.C. § 1035: This statute makes it a federal crime to knowingly and willfully falsify, conceal, or cover up by any trick, scheme, or device a material fact, or make any materially false, fictitious, or fraudulent statement in connection with the delivery of or payment for healthcare benefits, items, or services. The penalty for violating this statute includes a fine, imprisonment up to 5 years, or both.
Theft or Embezzlement in Connection with Healthcare - 18 U.S.C. § 669: This statute makes it a crime to embezzle, steal, or otherwise without authority knowingly convert to the use of any person other than the rightful owner, or intentionally misapply any of the moneys, funds, securities, premiums, credits, property, or other assets of a healthcare benefit program. The penalties for violating this statute include a fine, imprisonment up to 10 years, or both.
Anti-Kickback Statute - 42 U.S.C. § 1320a-7b(b): This federal law prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of federal healthcare program business. Violations of the Anti-Kickback Statute can result in imprisonment up to 5 years, a fine up to $25,000, or both. Violators can also be subject to three times the amount of damages sustained by the government.
False Claims Act - 31 U.S.C. §§ 3729 - 3733: This statute allows for penalties of $5,500 to $11,000 per false claim, and triple the amount of the government's damages.

Health Care Fraud Investigation Process

The Path to Uncovering Medicare Fraud: A Detailed Look

The fight against Medicare fraud is a top concern for the Justice Department, leading to the mobilization of various agencies, including the notable Medicare Fraud Strike Force, aimed at eradicating deceitful practices within Medicare. They operate in Detroit, Houston, Miami, and other areas. In these areas charges for health care fraud are much more common.

Click to read about recent health care fraud prosecution statistics

Unfortunately, this rigorous scrutiny often ensnares healthcare providers who may unknowingly deviate from compliance or engage in non-fraudulent activities. Experts with backgrounds in both State and Federal Medicare fraud analysis spearhead investigations, armed with the knowledge to both identify potential fraud and strategize defenses effectively.

Key Players in Medicare Fraud Investigations

The landscape of federal enforcement against Medicare fraud is vast, involving numerous entities. Investigations might kick off with a MAC audit, alerting the Office of Inspector General (OIG) upon suspicion, underscoring the critical nature of MAC audits for providers. Local US Attorney's offices, the FBI, and UPICs contracted by Medicare also play pivotal roles, with UPICs analyzing data for anomalies in billing practices that could indicate fraudulent activities.

Crucial Agencies Explained

HHS OIG: With a mission to safeguard HHS programs including Medicare, this agency deploys audits and investigations to detect and deter fraud.
Medicare Fraud Strike Force: A collaborative team focusing on the detection, prevention, and prosecution of fraud, utilizing data analytics to pinpoint suspicious activities.
DOJ: Integral to the legal proceedings, deciding on the pursuit of civil or criminal charges based on investigations.
FBI: A key investigative body in white-collar crime related to healthcare fraud.
MACs and UPICs: Frontline entities in identifying billing irregularities, conducting initial audits and investigations.

Investigation Process Unveiled

Step 1: Detection and Initial Analysis

Initiation: Investigations often start from anomalies detected during routine Medicare Administrative Contractor (MAC) audits, tips from whistleblowers, or data analysis indicating deviations from normal billing practices.
Data Analysis: Use advanced data analytics to identify unusual patterns, such as billing for services not rendered, upcoding, and other discrepancies.

Step 2: Preliminary Investigation

Desk Audit/Statistical Review: Conduct a detailed examination of the provider's billing data and compare it against typical billing patterns for similar services in the industry.
Inter-agency Collaboration: Engage with Unified Program Integrity Contractors (UPICs) to further analyze data and identify potential fraud.

Step 3: In-depth Investigation

Covert Investigation Phase: Without alerting the subject, gather more in-depth evidence through covert means, such as reviewing additional documents from various sources, conducting discreet interviews, and using subpoenas for obtaining records.
Overt Investigation Phase: Transition to more direct methods like issuing formal subpoenas, conducting on-site visits, and interviewing employees and patients.

Step 4: Referral for Prosecution

Compilation of Evidence: Organize and review all gathered evidence to build a strong case.
Inter-agency Review: Present findings to the Department of Justice (DOJ) and work with the Federal Bureau of Investigation (FBI) and the Health and Human Services Office of Inspector General (HHS OIG) for legal analysis and determination of prosecutable offenses.
Legal Proceedings: Assist in drafting the referral to the DOJ, outlining potential charges and participating in the strategy for grand jury presentations or direct filings.

Agencies Involved:

Medicare Administrative Contractors (MACs): Initial detection and audit.
Unified Program Integrity Contractors (UPICs): Data analysis and integrity checks.
Department of Justice (DOJ): Legal review and prosecution.
Federal Bureau of Investigation (FBI): Criminal investigations.
Health and Human Services Office of Inspector General (HHS OIG): Oversight and specialized investigations.

Defending Health Care Fraud Charges

Successful Defense Requires a Career’s Worth of Knowledge and a Sophisticated Defense

Defending charges of healthcare fraud, requires a sophisticated defense by defense council who are prepared and experienced in defending healthcare fraud charges.

Unfortunately, most attorneys who do not regularly practice in the healthcare fraud arena do not understand the complexities of medical billing requirements, Medicare rules and regulations such as LCDs and NCD. Many attorneys also don’t understand the complex decisions in Supreme Court and district court cases related to healthcare fraud.

Example Case Study United States v. Bothra

That’s why the defensive each case must be robust and aggressive to ensure success at trial or the best possible deal. Typically Ron Chapman starts his defense with a thorough investigation of the subject matter, for example, in a recent case where Ron received an acquittal a provider was charged with millions of dollars of healthcare fraud for doing unnecessary back injections.

The theory raised by the government was that the provider was getting patients hooked on pain medicine in order to over utilize interventional procedures. Well, many attorneys who defended other clients in the case, sit back and waited for discovery from the government, Ron and his team got busy developing a defense strategy. Ron and his team develops statistical data to show that this practice did not use more injections than their peers. Data also showed that many patients received medication and did not get injections. In addition, data also showed that many patients had better outcomes on the injections and were able to reduce the amount of pain medication that they took. After a thorough defense investigation, the data thoroughly showed that this was operating above Board and not committing healthcare fraud.

Result Acquittal in a $450 Million Health Care Fraud Case

Without such an investigation, a defendant has no chance of a trial victory, or of securing a deal that they are satisfied with. Many attorneys lack the resources the knowledge and the desire to aggressively attack the governments theory in order to improve a healthcare, fraud, defendants case posture.

While each and every defense of a case is unique, many healthcare, fraud, allegations have been repeated time and time again by the government. The government typically recycles, similar theories and similar cases. Having significant experience defending healthcare fraud charges across the country Ron has become familiar with these theories and can spot them coming a mile away. This helps a provider posture, their defense around that theory to achieve victory.

Defending Health Care Fraud Charges

Finding a Health Care Fraud Attorney

Amidst the legal turmoil healthcare fraud accusations bring, Ronald W. Chapman II offers not just hope but tangible results. With a storied history of acquittals and favorable outcomes, Chapman's defense strategies are tailored, tenacious, and tested. His victories span across a spectrum of healthcare fraud cases, affirming his position as a preeminent defense attorney in this complex field.

Results That Speak Volumes

Acquittals in Federal Charges: From Kentucky interventional pain physicians to renowned rheumatologists, Chapman has secured acquittals against daunting federal charges, showcasing his ability to navigate the intricacies of healthcare law successfully.
Dismissal of Charges: Cases involving serious allegations, including opioid trial charges and accusations of drug trafficking, have been dismissed under his defense, reflecting a deep understanding of both legal and medical nuances.
Successful Defense in High-Stake Cases: Chapman's strategic defense has led to the recapture of over $450 million for his clients in 129 recent counts of acquittal.

Your Defense Strategy

Choosing Ronald W. Chapman II means opting for a defense grounded in thorough investigation, personalized strategy, and an unwavering commitment to your rights and future. Understanding the gravity of healthcare fraud charges, Chapman employs his extensive knowledge and strategic acumen to navigate each case towards the best possible outcome, ensuring that your side of the story is heard, respected, and effectively represented.

Embark on Your Defense Journey

If healthcare fraud allegations cloud your horizon, let Ronald W. Chapman II illuminate your path to justice. With a proven track record, specialized expertise, and a compassionate approach to legal defense, Chapman stands ready to defend your rights, safeguard your professional integrity, and secure your future.

Contact Health Care Fraud Lawyer Ronald W. Chapman II

Contact

Health Care Fraud Prosecution Steps

For a more detailed guide on each aspect of the process please click the links below:

Grand Jury Target Letter: Notification of being under investigation. Counsel begins protective measures and strategizes defense.
Grand Jury Investigation: Evidence is reviewed by a grand jury to decide on charges. Defense counsel may start negotiations or prepare for potential indictment.
Defense Investigation: Counsel conducts a thorough investigation to counter government claims, gathering evidence and expert testimonies.
Indictment: Formal charges are filed if probable cause is found. Counsel reviews charges to develop defense strategies.
Arraignment: Defendant is formally charged and enters a plea. Counsel ensures the defendant understands their rights and the charges.
Detention Hearing: Determines if the defendant will be detained or released until trial. Counsel argues for the least restrictive conditions.
Discovery: Prosecution shares evidence with defense. Counsel scrutinizes evidence for weaknesses and formulates defense.
Pre-Trial Motions: Counsel may file motions to dismiss charges or suppress evidence, aiming to weaken the prosecution's case.
Trial: Evidence is presented before a judge or jury. Defense counsel challenges the prosecution's case, aiming for acquittal.

Ron has tried more health care fraud cases to acquittal than any other attorney in recent history. He is skilled at each stage of this process and expertly navigates his clients through health care fraud allegations to protect their rights.

Medicare Fraud and Medicaid Fraud a Crucial Difference

Medicare and Medicaid are two distinct programs providing health coverage. Medicare, established under Title XVIII of the Social Security Act, caters primarily to individuals over 65 and those with certain disabilities. Medicaid, under Title XIX of the same act, assists low-income individuals and families, with states and the federal government sharing costs.

Medicare fraud typically involves false claims to the federally administered program, while Medicaid fraud can involve practices against state-managed programs, often run by private insurers. Consequently, Medicare fraud is generally a federal concern, whereas Medicaid fraud can involve both state and federal jurisdictions, leading to variations in how allegations are handled and in the potential penalties imposed. The expertise of counsel, particularly those with a track record of healthcare fraud acquittals, is crucial due to the complex nature of these cases and the differences between defending against allegations in federal versus state contexts.

Health Care Fraud Sentences

The Federal Sentencing Guidelines for health care fraud in the United States are part of the broader Federal Sentencing Guidelines, which are designed to provide a framework for sentencing individuals convicted of federal crimes, including health care fraud. Health care fraud can encompass a wide range of activities, such as billing for services not rendered, billing for more expensive services than those actually provided, or performing unnecessary services for the purpose of billing. The specific guidelines for health care fraud are detailed in the Guidelines Manual.

Calculation of Sentences Using the Guidelines

The calculation of sentences under the Federal Sentencing Guidelines involves a two-step process:

Determination of the Base Offense Level: The base offense level for health care fraud is determined by the amount of loss caused by the fraudulent activity. The Guidelines specify increasing offense levels based on the monetary value of the loss, with higher amounts of loss resulting in higher base offense levels.
Adjustments: After determining the base offense level, adjustments are made based on specific characteristics of the offense or the offender. These can include upward adjustments for factors such as the involvement of sophisticated means, the defendant’s role in the offense, or whether the fraud endangered the welfare of individuals. Downward adjustments may apply if the defendant accepts responsibility for the offense.

Specific Guidelines and Enhancements

Loss Amounts: The Guidelines use the amount of loss to the victims as a primary determinant of the offense level. The Guidelines table specifies offense levels for loss amounts, starting from less than $6,500 to more than $550,000,000, with corresponding offense levels ranging from level 6 to level 38.
Sophisticated Means: If the fraud involved sophisticated means, such as elaborate schemes to hide the fraudulent activity, an increase in the offense level is warranted.
Role in the Offense: Defendants who organized, led, managed, or supervised the fraudulent activity may receive an increase in their offense level.
Number of Victims: If the fraud affected a large number of victims, additional points might be added to the offense level.

Typical Health Care Fraud Sentences

Sentences for health care fraud can vary widely based on the specifics of the case, including the amount of loss, the defendant’s criminal history, and other factors mentioned above. Sentences can range from probation for cases involving lower amounts of loss and no prior criminal history, to several years in prison for cases involving significant loss or harm to victims.

Probation to Short-term Imprisonment: For lower levels of loss without aggravating factors, sentences may range from probation to short-term imprisonment.
Moderate to Long-term Imprisonment: For significant loss amounts, especially those involving sophisticated schemes or a large number of victims, the guidelines recommend moderate to long-term imprisonment.

It's important to note that while the Federal Sentencing Guidelines provide a framework, judges do have discretion to impose sentences outside these guidelines under certain circumstances. This can include considerations of the defendant’s history, cooperation with authorities, the impact of the fraud on victims, and other factors.

Unlock the Secrets of Federal Criminal Defense – Free Chapter Inside!

Discover the untold strategies used to secure acquittals in federal criminal cases. Authored by Ronald W. Chapman II, a leading federal defense attorney, this book provides insider knowledge on navigating and overcoming federal investigations.