I’ve been charged with healthcare fraud! What should I do?

According to the National Health Care Anti-Fraud Association, the annual cost of healthcare fraud in the United States is nearly seventy billion dollars. Healthcare fraud and abuse is considered a federal crime. Additionally, there are also state-level crimes for healthcare fraud and abuse in the state of New Jersey.

If you or a loved one or your organization has been accused of healthcare fraud and abuse, it’s incredibly important that you understand the nature of this crime, what you should do if you’ve been charged with this cime, and what your options are in creating the best possible defense in the protection of your freedoms.

What is healthcare fraud and abuse?


There are a wide variety of activities that can fall under the banner of “healthcare fraud” and it’s a crime that can be committed by an equally wide variety of people, including patients, health administrators, physicians, billing and coding specialists, and even insurance companies.

The most important factor in defining guilt in regard to healthcare fraud is by proving the intentional acts that are conducted knowingly to gain benefits, financial or otherwise, that would not normally be obtained were the proper procedures followed.

Bear in mind that this is distinctly different from mistakes as they relate to patient billing or the like. Healthcare fraud and abuse is taken very seriously and can result in serious penalties, including fines and even lengthy prison sentences.

Healthcare fraud and abuse activities can include:


Upcoding — the intentional miscoding of a medical procedure in order to increase reimbursement
Medical billing fraud — an example of this can include when a patient is inappropriately or inaccurately billed for medical services they received
Billing for nonexistent work — this is where a patient is billed for services that were never conducted
Unnecessary procedures — this is another example of attempting to increase medical reimbursements through conducting services or procedures that aren’t medically necessary
Unnecessary Durable Medical Equipment (DME) — this is billing for equipment that is not necessary for the patient’s health
Solicitation for unnecessary procedures — again, this is an act designed to increase medical reimbursements
Kickbacks or self-referrals — this is in regard to remuneration in exchange for patient referrals or the act of referring patients to oneself in order to increase payment
Medicaid and Medicare fraud — these can include the same acts described above but pertain specifically to those that pertain to government healthcare programs
False persons named in insurance policy — this is an example of insurance fraud
Prescription fraud — prescription fraud can be conducted either by patients or doctors, and includes the solicitation or prescription of drugs that have fulfill no medical purpose

What do I do if I’ve been charged with healthcare fraud and abuse?


Don’t panic — This is an important one. While it’s of course incredibly serious to be charged with a federal crime, one of the best things you can do is remain calm, remain focused, and to not carry out actions that can be perceived by authorities as erratic, suspicious, or as contributors to your alleged guilt. Your legal journey will be that much easier to navigate if you have a good head on your shoulders.

Don’t speak to authorities without consulting an attorney first. — Remember the importance of your Miranda rights. You have the right to remain silent, because anything you say can and will be used against you in a court of law. People accused of crimes will often instinctively begin bargaining with authorities in order to make charges go away. They will not. If you’ve been charged, then this means that prosecutors feel like they have a strong case against you. Be calm. Be polite. But keep quiet and use your right to secure an attorney — as soon as you possibly can.

Secure a criminal defense attorney — This is absolutely essential. In order to protect your freedom and create the best possible legal outcome for yourself, you need to secure a criminal defense attorney. Immediately. Firms like The Law Offices of Robert J. DeGroot have extensive experience in protecting defendants in New Jersey who have been charged with healthcare fraud and abuse.

Be honest with your attorney. Seriously. — There are so many things that a criminal defense attorney is responsible for when creating your legal defense that your absolute honesty is a must. So choose someone you trust! Your relationship with your defense attorney is just that, a relationship and it needs to be built on trust in order to be successful. Don’t hide things, like facts, details, documents, or the like. Follow their advice. When you have meetings, be on time and be prepared. Show respect for the fact that your freedom might hang in the balance and if your goal is to protect that freedom, then help your attorney help you preserve it!

Have you been charged with healthcare fraud and abuse?
You deserve the best defense!


Time is of the essence! And early intervention is key to an early resolution. Call The Law Offices of Robert J. DeGroot today to protect your freedom, regardless of how dire you feel your situation might be. We have the skills, experience, and proven track record of success in cases like yours. Call us today!