Erie Healthcare Fraud Lawyer

Erie is home to renowned hospitals and medical schools like Saint Vincent Hospital and Gannon University’s School of Nursing. But even here, medical professionals can be accused of committing fraud. If you were accused of this type of white-collar crime, you can rely on our Erie, PA, healthcare fraud lawyer. Our law firm understands the state’s criminal laws and how to help doctors and hospital administrators fight serious criminal charges.

A Trusted Criminal Defense Firm Serving Erie

At the Levenson Law Firm, we understand the stress that can accompany allegations of healthcare fraud. Federal prosecutors are equipped with extensive resources to pursue convictions, making it imperative to have experienced legal representation. Our criminal defense attorneys can tirelessly fight for your rights and advocate for a fair outcome to your case that allows you to avoid serious penalties.

Understanding Healthcare Fraud in Pennsylvania

Healthcare fraud occurs when individuals or organizations knowingly submit false or misleading claims to insurance providers or government entitlement programs like Medicaid or Medicare. In Pennsylvania, where healthcare systems process millions of bills every year, even small inaccuracies can trigger audits or federal investigations.

UPMC Hamot, a 446-bed hospital, reported $512 million in net patient revenue and $551 million in operating expenses in 2023 alone. Fraudulent activity can include acts like billing for services not rendered, upcoding, or kickback schemes. At Saint Vincent Hospital, the average inpatient charge for cardiology-related treatment was $53,860 in 2023, which is a reminder of the high cost of medicine in Erie and the potential for fraudulent acts.

Facilities like Millcreek Community Hospital, which handles around 9,600 emergency visits per year, generate thousands of individual claims that must meet federal guidelines. Given the complexity and volume of healthcare transactions, honest mistakes and intentional fraud can lead to serious legal consequences.

Consequences of Healthcare Fraud Convictions in Erie

Healthcare fraud convictions in Erie can carry serious consequences, including fines, restitution, and potential incarceration. A conviction may also lead to exclusion from Medicare and Medicaid programs, loss of professional licensing, and permanent damage to your reputation.

Even billing mistakes at smaller facilities like Millcreek Community Hospital can lead to audits or federal investigations. In a notable Erie case, the owners of Hertel & Brown Physical & Aquatic Therapy faced significant prison time and restitution payments due to fraudulent billing practices. Once charged, individuals often face not only legal penalties but also the long-term challenges of rebuilding their careers and professional trust within Erie’s close-knit medical community.

Why You Need Aggressive Defense for Healthcare Fraud in Erie

An experienced defense attorney can scrutinize the prosecution’s evidence, challenge the validity of investigative methods, and advocate for reduced charges or case dismissal. Having an advocate on your side during a difficult time can provide you with the resources to fight your charges so you do not face the most serious consequences under the law.

In some cases, a favorable plea bargain agreement can allow you to put the ordeal behind you without having to worry about facing serious jail or prison time. An attorney can play an important role in securing plea bargain agreements from prosecutors by emphasizing mitigating factors in your case, such as a clean criminal record.

Given the complexities of healthcare regulations and the severity of potential penalties, securing knowledgeable counsel is essential to protect your professional standing and personal freedom.

FAQs

Q: How Do Prosecutors Prove Healthcare Fraud?

A: To prove healthcare fraud, prosecutors must establish that a person intentionally submitted false claims or misrepresented medical services to receive payment. Evidence often includes manipulated billing records, falsified documentation, and testimony from employees or whistleblowers.

Repeated billing patterns can indicate fraud, such as upcoding or charging for services never rendered. Crucially, the government must prove deliberate intent, not an honest mistake. Challenging the accuracy of records or the presence of intent is often central to a strong defense.

Q: What Is the Burden of Proof in an Insurance Fraud Case?

A: In criminal court, the burden of proof in an insurance fraud case is beyond a reasonable doubt. That requires clear evidence that someone intended to deceive for financial gain. Civil fraud cases follow a lower standard and are often based on the balance of evidence. Identifying gaps in documentation or motive can raise doubt and lead to reduced charges or even a complete dismissal.

Q: What Should I Do if I’m Accused of Healthcare Fraud?

A: If you are accused of healthcare fraud, stay silent and contact a criminal defense attorney immediately. Do not speak to investigators or hand over documents until your lawyer has reviewed your situation. Early mistakes can hurt your case. An attorney can evaluate the charges, protect your rights, and begin building a strategy to resolve the matter as efficiently and favorably as possible.

Q: How Long Does a Medicaid Fraud Investigation Take?

A: The duration of a Medicaid fraud investigation depends on the complexity of the claims and the agencies involved. Some investigations are concluded in a matter of months, while others can extend over a year. Investigators scrutinize billing patterns, patient records, and provider histories. Delays often occur as each transaction needs thorough verification. Staying proactive and fully prepared throughout the investigation is key to minimizing the risk of criminal charges.

Q: Can Billing Mistakes Lead to Criminal Charges?

A: Yes, billing mistakes can lead to criminal charges. In complex systems like hospital billing or private practice management, honest errors can be misinterpreted as intentional fraud. If a pattern of incorrect billing is found, prosecutors may argue it was deliberate.

The distinction between a mistake and a crime often comes down to documentation and context. An experienced defense attorney can help show that any discrepancies were unintentional and not part of a fraudulent scheme.

Protect Your Rights With Strategic Healthcare Fraud Defense

Being accused of healthcare fraud in Erie can have devastating consequences for your career and personal life. The Levenson Law Firm is committed to offering aggressive and strategic defense to protect your rights and secure a favorable resolution for your case. Our father-daughter team has a proven track record of successfully defending clients against healthcare fraud charges.

With over five decades of combined experience, we are skilled in analyzing complex healthcare fraud cases, challenging evidence, and ensuring every detail is thoroughly reviewed. Contact our office today to schedule your consultation and take the first step toward defending your future.