Pennsylvania federal healthcare fraud lawyer

Federal health care fraud can take many forms, including submitting false or inaccurate Medicare claims, billing for services that were never provided, billing for nonexistent patients, upcoding services to receive higher reimbursements, billing for medically unnecessary services or equipment, prescription fraud, improper physician self-referrals, and paying or receiving kickbacks for patient referrals. Federal investigations may therefore focus heavily on billing practices, medical records, financial records, claims, emails, text messages, tax documents, and other communications that could show whether fraudulent activity occurred.

Federal health care fraud charges in Pennsylvania can carry serious criminal, financial, and professional consequences, including federal prison time, substantial fines, repayment obligations, exclusion from federal health care programs, and potential effects on a provider’s medical license or hospital privileges. An important element in a criminal federal health care fraud case is intent: the government must prove beyond a reasonable doubt that the defendant intended to commit fraud. As a result, defenses discussed on the page include lack of intent, insufficient evidence, entrapment, consent, and mistaken identity, with mistakes or human error potentially distinguished from intentional fraudulent conduct.

Where federal health care fraud charges are prosecuted in Pennsylvania

Federal healthcare fraud crimes in Pennsylvania are prosecuted in the federal court system, with cases generally handled in one of the state’s three U.S. District Courts based on where the alleged offense occurred. Philadelphia is a major court location for the U.S. District Court for the Eastern District of Pennsylvania, Pittsburgh for the Western District of Pennsylvania, and Harrisburg for the Middle District of Pennsylvania. All three federal judicial districts in Pennsylvania fall within the jurisdiction of the U.S. Court of Appeals for the Third Circuit. The specific district and court location where a federal healthcare fraud case is prosecuted generally depends on where the alleged criminal conduct occurred and the counties served by that district.