Defending NY Acupuncturist in a $9 Million Healthcare Fraud Case

In the case of the recent health care fraud scheme implicating a New York acupuncturist, who has admitted to a $9 million fraud targeting Amtrak, Varghese Associates, P.C., steps forward as the defense firm representing the accused. Our approach in defending our client underscores our commitment to ensuring a fair legal process and advocating for our client’s rights and interests.

At Varghese Associates, P.C., we understand the complexity of healthcare fraud cases and their significant implications for all parties involved. In defending our client, our strategy is rooted in a meticulous examination of the legal and factual aspects of the case. We aim to present a comprehensive defense that considers the circumstances leading to the charges against our client.

Our defense acknowledges the seriousness of the allegations while emphasizing the importance of distinguishing between intentional fraud and the complexities inherent in healthcare billing practices. We are exploring all avenues to ensure that our clients actions are put into context, highlighting any mitigating factors that may exist. We aim to ensure that the court receives a full and balanced view of the case beyond the initial charges.

We are committed to transparency and cooperation with the authorities while rigorously defending our client’s rights. The legal process is an opportunity to examine not just the actions of an individual but also the systemic issues that may contribute to such situations. Varghese Associates, P.C., is dedicated to navigating this process with professionalism and integrity, ensuring that justice is served while advocating for fair treatment and consideration of our client.

As the case progresses towards sentencing, scheduled for July 16, 2024, we will continue to work tirelessly on behalf of our client. We focus on presenting a defense that accurately represents her interests, seeking a just and equitable outcome. The charge of conspiracy to commit healthcare fraud carries significant penalties, and we are fully engaged in the legal process to advocate for a fair resolution.

Varghese Associates, P.C. appreciates the complexity of this case and its impact on all involved, including the Amtrak health care system and its beneficiaries. We believe in the legal system’s ability to adjudicate complex cases fairly and are committed to upholding the highest standards of legal defense for our clients.

For more information and updates on the case, please visit our website or contact our office directly.

What is Healthcare Fraud?

Healthcare fraud involves an individual or entity’s intentional deception or misrepresentation, knowing that the misrepresentation could result in some unauthorized benefit to themselves or another person or entity. This fraud can affect public and private health plans, including Medicare and Medicaid, in the United States. The primary goal of healthcare fraud is typically financial gain. The methods and schemes can vary widely, but some common examples include:

• Billing for Services Not Rendered: Submitting claims for medical services, treatments, or procedures never provided to the patient.
• Upcoding Services and Procedures: Billing for more expensive services or procedures than were performed, often by using a code that carries a higher reimbursement rate.
• Performing Unnecessary Services: Providing and billing for medically unnecessary services to generate insurance payments.
• Misrepresenting Non-Covered Treatments: Billing for a non-covered service as a covered service, such as cosmetic surgeries often not covered by health insurance.
• Falsifying a Patient’s Diagnosis: Adding false diagnoses to patient records to justify tests, surgeries, or other procedures that aren’t medically necessary.
• Kickbacks and Bribery: Receiving or paying compensation for referring patients for specific medical services or prescribing certain drugs.
• Phantom Billing: Billing for more visits than the patient attended or for patients who do not exist.
• Identity Theft: Using someone else’s insurance information to receive healthcare services or to fill prescriptions.

Common Defense Against Healthcare Fraud Accusations

Defending against healthcare fraud accusations requires a nuanced and strategic approach, given the complexity of healthcare laws and the potential for severe penalties. Whether the accusations are related to billing irregularities, unnecessary services, or kickbacks, a robust defense is crucial. Here are common defense strategies against healthcare fraud accusations:

1. Lack of Intent

One of the most powerful defenses is proving a lack of intent to commit fraud. Healthcare fraud requires intentional deceit or misrepresentation. Demonstrating that any billing errors or irregularities were due to mistake, confusion, or negligence, rather than a deliberate attempt to defraud, can be an effective defense. This might involve showing that the accused believed in good faith that the billing practices were appropriate and compliant with regulations.

2. Reliance on Professional Advice

Healthcare providers often rely on billing specialists, consultants, or legal advisors for guidance on complex billing practices and compliance issues. A defense can argue that the accused acted based on professional advice, believing it to be correct. This strategy underscores the reliance on expert guidance in navigating the healthcare system’s complexities.

3. Insufficient Evidence

The prosecution must prove beyond a reasonable doubt that fraud occurred. Challenging the sufficiency and reliability of the prosecution’s evidence can be a key defense strategy. This might involve questioning the accuracy of documentation, the credibility of witnesses, or the interpretation of billing codes and regulations.

4. Corrective Actions

If billing errors or compliance issues were identified and promptly corrected, this can be used in defense to demonstrate a commitment to compliance and rectifying mistakes. Voluntary disclosure of errors and repayment of any overcharges before an investigation begins can also be a mitigating factor, showing good faith efforts to comply with the law.

5. Ambiguity in Regulations

Healthcare billing and coding regulations can be highly complex and subject to interpretation. A defense may argue that the accused’s actions were based on a reasonable interpretation of ambiguous rules or guidelines. This strategy can be particularly effective in cases where regulations have changed or where official guidance is lacking.

6. Entrapment

Though rare, a defense of entrapment may be applicable if it can be shown that government agents induced the accused to commit a crime they would not have otherwise committed. This defense requires proving that the initiative for the fraudulent conduct originated with the authorities, not the defendant.

Signs You Are Being Investigated for Healthcare Fraud

Being under investigation for healthcare fraud can be a distressing experience, with significant legal, financial, and reputational implications. Healthcare fraud investigations often begin long before the individuals or entities involved are formally notified. Recognizing the early signs of an investigation can provide crucial time to prepare and seek legal counsel. Here are key indicators that you might be under investigation for healthcare fraud:

• Unusual Requests for Records: Extensive requests for patient records, billing documentation, or other information outside of routine audits.
• Interviews with Patients or Employees: Federal agents or insurance representatives interviewing your patients, employees, or associates.
• Subpoenas or Search Warrants: Receiving a subpoena for documents or a search warrant executed at your office, home, or storage facility.
• Banking and Financial Inquiry Notices: Notices from banks or financial institutions about government inquiries into your accounts.
• Changes in Payment Patterns: Delays, withholding, or additional scrutiny of reimbursements from Medicare, Medicaid, or private insurers.
• Contact by Former Employees or Associates: Unexpected outreach from former employees or business associates, especially regarding billing practices.
• Colleagues Facing Similar Issues: Discovering that colleagues, particularly those in the same specialty or area, are under investigation.
• Legal or Professional Notices: Correspondence from professional boards or licensing agencies requesting information or notifying you of complaints.

What To Do If You’re Charged With Healthcare Fraud

Being charged with healthcare fraud is a serious matter that requires immediate and strategic action. Healthcare fraud charges can lead to severe penalties, including fines, restitution, and imprisonment, not to mention the potential damage to your professional reputation and career. If you find yourself facing such charges, here are essential steps to take:

• Stay Calm and Analyze the Charges: Understand the specifics of what you’re accused of.
• Do Not Discuss the Case: Only talk about your case with your attorney to avoid self-incrimination.
• Hire a Specialized Defense Attorney: Find an attorney with experience in healthcare fraud defense.
• Gather and Preserve Evidence: Compile relevant documents, records, and correspondence.
• Comply with Legal Obligations, but Protect Your Rights: Follow legal requests but safeguard your rights with your attorney’s guidance.
• Consider the Impact on Your Professional License: Address potential licensing issues with your attorney.
• Develop a Defense Strategy: Work with your attorney to challenge evidence or negotiate a plea.
• Stay Informed and Involved: Actively participate in your defense and stay updated on your case.
• Consider the Public Relations Aspect: Manage the impact on your reputation if your case is public.
• Prepare for the Long Haul: Brace yourself for a potentially lengthy and challenging legal process.

How a Healthcare Fraud Defense Lawyer Can Help

We understand the complexities and challenges that healthcare professionals face when accused of fraud. Our team of experienced attorneys is dedicated to providing robust legal representation and support throughout the entire legal process. Here’s how we can help if you’re facing healthcare fraud charges:

• Experienced Legal Representation: Our criminal defense attorneys have extensive experience in healthcare law and fraud defense, ensuring you receive knowledgeable and effective representation.
• Strategic Defense Planning: We work closely with you to develop a comprehensive defense strategy tailored to the specifics of your case, aiming to protect your rights and achieve the best possible outcome.
• Navigating Complex Regulations: Healthcare law is complex and ever-changing. We stay abreast of the latest legal developments to navigate these complexities on your behalf.
• Challenging Prosecution Evidence: Our team meticulously reviews the prosecution’s evidence, identifying weaknesses and inaccuracies to challenge their case against you.
• Protecting Your Professional License: Healthcare fraud charges can threaten your professional license. We advocate for you in front of licensing boards and professional associations to safeguard your career.
• Negotiating Plea Deals: When appropriate, we negotiate with prosecutors to secure plea deals that minimize the consequences of the charges against you.
• Preserving Your Reputation: We understand the importance of your professional reputation. Our firm employs strategies to manage public perception and mitigate damage to your standing in the community.
• Comprehensive Support: Beyond legal defense, we provide support and guidance on compliance, regulatory matters, and the potential impacts on your practice and personal life.
• Transparent Communication: Keeping you informed every step of the way, we ensure you understand your legal options and the implications of the decisions made in your case.
• Emotional and Psychological Support: Facing fraud charges can be stressful. We offer compassionate support, helping you navigate the emotional challenges of the legal process.

Facing Healthcare Fraud Charges? Let Us Defend Your Future

You don’t have to face the complexities of healthcare fraud allegations alone if you’re navigating them. Our experienced healthcare fraud defense lawyers are here to guide you through every step of the process, ensuring your rights are protected, and your side of the story is heard. With a deep understanding of healthcare law and a commitment to our clients, we’re ready to build a strong defense on your behalf.

Don’t let accusations define your future. Contact us today for a consultation and take the first step towards securing your professional and personal reputation.