Health Care Fraud


If you are being investigated or have been charged with a health care fraud related offense contact health care fraud criminal defense attorney Michael C. Rosenblat a former prosecutor with the Illinois Medicaid Fraud Control Unit.

Typical health care fraud cases include Medicare Fraud, Medicaid Fraud, or Kickbacks.

Medicare and Medicaid fraud can involve overbilling, billing for services that were not provided, or billing for services that are not reimbursable either because they are fraudulent or because the services fail to qualify for reimbursement. Kickbacks are not only illegal but are viewed as damaging the integrity of health care programs by creating a conflict of interest between the provider, to provide the best services for patients, and the providers own financial interest.

Health care fraud can so include physicians who prescribe medications not for a legitimate medical purpose, such as physician’s accused of operating a “pill mill.”

Health care fraud alleged to have been committed against Medicare, Medicaid, or a private health insurance company, can include offenses related to the Anti-Kickback Statute, prescribing medications including controlled substances without being medically necessary, billing for services never provided, submitting duplicate claims for the same service, billing for non-reimbursable or medically unnecessary services by falsely claiming that the services were reimbursable or medically necessary, using staff or assistants to provide health related services and then billing as though the services were provided by a physician, and waiving co-pays. These cases often involve an analysis of the relationship between the entities when a kickback allegation is brought, and often an analysis of the CPT Codes, ICD-9 Codes, and even DRG’s when the allegation is one related to the submission of false claims to Medicare, Medicaid, or a private health insurance company.

Health Care Fraud prosecutions under 18 U.S.C. 1347 have been increasing over the past several years and have increased by almost 10% in the last 10 years. Most of these cases are being investigated by the FBI, followed by Health and Human Services (HHS). The Southern District of Illinois is ranked first in the number of Health Care Fraud Prosecutions, based on per capita, for 2013; also in the top 10 were the Northern District of Indiana and the Eastern District of Michigan.

With Health Care Fraud estimated to cost the United States over $80 billion a year and increasing, the FBI uses statistical data, obtained from agencies such as the Centers for Medicare and Medicaid Services (CMS), Health and Human Services (HHS), and State Medicaid Agencies, such as the Illinois Department Healthcare and Family Service (HFS), and the State Medicaid Fraud Control Units (MFCU). Law Enforcement techniques have included the use of task forces such as Health Care Fraud Prevention and Enforcement Action Team (HEAT), and undercover operations.

Defense of health care fraud cases can often include the use of statistical analysis. The government or defense may try to use statistics to support or refute evidence of fraud, and may use statistics to support relevant conduct accusations for sentencing purposes.

If you are being investigated, suspect that you are being investigated, or have been charged with a health care fraud related offense contact health care fraud criminal defense attorney Michael Rosenblat at 847-480-2390, or online.

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