Long Island Healthcare Fraud Lawyer

Healthcare fraud is investigated and prosecuted very harshly, so healthcare practitioners and businesses need to have strong legal representation when facing fraud allegations. There are many ways that fraud can occur in healthcare businesses, from billing violations to referral kickback violations. If you are facing investigation or accusations of fraud, you need a Long Island healthcare fraud lawyer to protect your rights, reputation, and future.

Navigating Healthcare Fraud Laws With Weiss Zarett Brofman Sonnenklar & Levy, P.C.

Fraud cases can lead to fines, administrative penalties, and even the potential for criminal charges. It is crucial to act soon if you are aware of a complaint or investigation into your practice or business for fraud.

You need the seasoned attorneys at Weiss Zarett Brofman Sonnenklar & Levy, P.C., to gather evidence and create a defense against initial audits or investigations. We can also fight for you if the case goes to court. Our firm has professional experience with the 10th Judicial District, which serves Long Island counties, as well as many other courts that handle these fraud cases.

Whether you are facing accusations of Medicaid fraud, up-charging, self-referral violations, or prescription drug fraud, our firm can explore your legal options. We can defend your interests during investigations, audits, and other reviews for fraud. Accusations of fraud can impact your standing, reputation, and career. It is essential to take all the steps necessary to defend your practice and business.

At our firm, we care about our clients, and we want to fight for your future. Our attorneys will handle our clients’ cases personally, so your case can be managed by a seasoned legal professional.

What Are Types of Healthcare Fraud in Long Island?

Healthcare providers are at the intersection of business law, employment law, healthcare law, and many other areas of regulation. Failure to be aware of and adhere to these regulations can lead to serious issues, including committing many types of fraud. In 2024, there were 848 adverse actions taken against medical practitioners in New York, including nearly 300 against physicians and more than 120 against registered nurses.

While most types of fraud require intent, not all do. Some cases of fraud can still lead to financial and administrative healthcare fraud penalties, even if the fraud wasn’t intentional. Some types of fraud that we can handle at Weiss Zarett Brofman Sonnenklar & Levy, P.C., include:

Medicare and Medicaid Fraud

This fraud occurs when a medical provider fraudulently bills Medicare or Medicaid, and it is considered fraud, regardless of whether the individual knew that the claims were fraudulent or not. Healthcare businesses may:

• Submit false claims to receive reimbursement.
• Up-code or bill higher for services provided.
• Engage in other types of Medicaid or Medicare fraud.

These fraud and abuse cases are prohibited by the False Claims Act. If you have been accused of False Claims Act violations, you need a skilled attorney.

Billing Fraud

Medical providers can also be charged with billing fraud against private insurance companies, patients, and other parties. This could include:

• Billing for services never rendered
• Up-coding
• Phantom billing for deceased patients
• Recommending medically unnecessary services

It also includes unbundling, which occurs when a provider bills for services separately that are less expensive when billed under a single code, as they are meant to be.

Stark Law Violations

This type of fraud occurs when providers engage in self-referrals to services or entities with which the provider has a financial relationship. You do not have to intend to commit this type of fraud to be held liable for it. Self-referral violations can have serious consequences for medical professionals. It is crucial that accusations are treated seriously and that businesses and providers hire skilled attorneys to protect their interests.

Anti-Kickback Law Violations

The Anti-Kickback Statute prohibits the use of rewards of any kind to providers for referring services, prescription drugs, or medical supplies, especially when those services are paid for by Medicaid, Medicare, or another federal healthcare program. The rewards do not have to just be cash; they can also be:

• Expensive vacation stays
• Paid rent
• Excess employment compensation
• Any other gifts

This offense is criminal when the provider knowingly and willingly commits the offense.

Prescription Drug Fraud

This includes:

• Distributing a controlled substance outside a professional practice
• Overprescribing substances
• Diverting substances
• Prescribing drugs that are not medically necessary
• Any other improper prescribing practices

It is crucial to work with a legal team that understands the intricacies of these offenses and how to defend against them.

Mail and Wire Fraud

This is the offense of using mail or electronic communications to defraud, and it can occur in healthcare settings. Accusations of this type of fraud require proof of intent to defraud. When you hire a healthcare fraud lawyer, they can gather evidence of a lack of intent or review other options for defense.

Licensing or Identity Theft Fraud

Licensing fraud occurs when healthcare providers practice despite not having a valid license, and it also occurs when an individual steals the identity of a provider. Identity theft in healthcare may involve stealing the identification or credentials of the provider, usually to bill for healthcare services. This offense can be charged criminally.

What a Healthcare Defense Attorney Can Do for You

When you are faced with accusations, investigations, or audits for these fraud offenses, you need to take action to protect your interests. A skilled healthcare fraud defense attorney can navigate these preliminary investigations against you, your license, and your business. Their work can potentially prevent more serious issues, like criminal charges. Your attorney can gather evidence, determine if any laws were broken, and help you make informed choices about what to do next.

The strategic support of a defense attorney is crucial to protect your future, practice, and reputation. During audits, your attorney can prepare information ahead of time and address any discrepancies. They can also respond to or appeal any audit reports. When appropriate, your attorney can negotiate settlements to prevent more serious issues.

If an investigation has begun, your attorney can engage with the investigative team prior to charges being filed. They can potentially get your charges reduced or prevent them altogether. Additionally, your attorney can create a regulatory compliance plan to avoid similar issues in the future.

Contact a Dedicated Long Island Healthcare Fraud Attorney Today

You don’t have to deal with serious healthcare fraud allegations by yourself. Instead, protect your rights and what you have worked so hard for by contacting Weiss Zarett Brofman Sonnenklar & Levy, P.C., today.