Healthcare fraud is classified as a white collar crime in which individuals or organizations intentionally submit false claims or misrepresent information to receive unwarranted payments from healthcare programs. This crime can be committed by medical providers, patients, or third parties.
Healthcare Fraud in the News
Raju Sharma, 61, was charged with conspiracy to commit healthcare fraud for his role in a scheme that allegedly defrauded Medicare of nearly $30 million. On behalf of Pharmagears and RR Medco, Sharma allegedly contracted with telemarketing firms to generate fraudulent orders for durable medical equipment (DME). Documents allege that these orders were often medically unnecessary, unwanted by beneficiaries, or procured using stolen provider information. To further the alleged fraud, Sharma paid the telemarketers based on the number of orders rather than a flat fee, potentially violating the Anti-Kickback Statute. His companies ultimately billed Medicare for approximately $29.6 million and received $15.8 million in payments. Sharma also used profits from the alleged fraud to purchase luxury goods, including two Ferraris, a Mercedes-Benz Model S and at least three Rolex watches. The Court issued seizure warrants for these luxury goods. Sharma is alleged to have worked with multiple co-conspirators.
What is Healthcare Fraud?
Healthcare fraud may involve:
Billing for services not rendered: Providers may submit claims for treatments or procedures that were never provided.
Upcoding: This involves billing for more expensive services than those actually performed.
Phantom billing: Submitting claims for nonexistent patients or services.
Duplicate claims: Filing multiple claims for the same service.
Kickbacks: Offering or receiving payment for patient referrals.
What are the Punishments for Healthcare Fraud?
The penalties associated with conspiracy to commit healthcare fraud are severe and can vary. A conviction can result in up to 10 years in prison for conspiracy, with potential increases to 20 years if the fraud results in serious bodily injury or death. Offenders may also face substantial fines, which can reach up to $250,000 or more depending on the extent of the fraud and additional charges involved.
Offenders may incur civil liabilities under various statutes, including the False Claims Act, which can lead to further financial penalties.
Conspiracy to commit any crime may involve a wide net of alleged co-conspirators who can be convicted for serious crimes that the prosecution will strive to prove direct involvement in. The charge of conspiracy can affect many people beyond the alleged ringleader.
Conspiracy to commit healthcare fraud not only carries the risk of long prison sentences but also significant financial repercussions and professional consequences, such as loss of medical licenses. Skilled legal representation is essential to help individuals accused of such crimes navigate complex healthcare regulations, challenge evidence, and build a strong defense. With aggressive prosecution in these cases, having a knowledgeable white collar criminal defense attorney is critical. At Dhar Law, LLP, our experienced, award-winning white collar defense team work with our clients to build a robust case to defend the rights of the accused. Contact us at (617) 880-6155 to learn more about our healthcare fraud defense services.
