VA Healthcare Fraud Defense Attorney
All members of the military and individuals who have previously served in the military are entitled to received healthcare through the VA (Veterans Affairs). The VA medical benefits for past and present military members is supported and funded by the federal government. Until recently, individuals receiving medical care through the VA could only seek treatment at VA hospitals and clinics. Now, through legislation, individuals can seek medical care at certain non-VA facilities and this care will still be funded by the government.
Since VA healthcare benefits are funded by the federal government, fraud against the VA program will subject you to federal penalties. VA healthcare fraud is charged and prosecuted the same as fraud perpetuated against other federal healthcare payors like Medicare and Medicaid. Federal healthcare fraud is generally charged under 18 U.S.C. §1347. This statute makes it illegal to defraud a federal healthcare payor. Under this statute, an individual faces up to 10 years in prison. Sentencing for a conviction of healthcare fraud depends on the amount of money the federal payor was defrauded out of.
Schemes involving VA healthcare fraud can include the following:
- Submitting claims for payment to the VA for medical services not provided
- Submitting claims for payment to the VA for medically unnecessary services
- Submitting claims for payment to the VA for medical services performed as a result of a kickback or any other form of remuneration
- Submitting claims for payment to the VA for knowingly up-coded medical services.
It is important to note that the VA is not the same as Tricare. Tricare is also a federally funded health insurance program available to military members, but is separate from the VA. As with the VA and all other federally funded healthcare programs, fraud against the Tricare program invokes the same federal healthcare statute and its requisite penalties.
If you are under investigation for VA healthcare fraud, there are several ways to be put on notice of such an investigation. A federal agent could come to your home and ask to speak with you. You could receive a target letter from the U.S. Attorney’s Office stating you are the target of a healthcare fraud investigation. You could also receive a request for documents, such as a Grand Jury Subpoena issued by the government. You might also suspect an employee or former employer of yours thinks fraud is occurring in your practice and might report you to federal authorities. Regardless of how you discover you are facing potential VA healthcare fraud charges, it is imperative you speak with an experienced federal defense attorney to mitigate exposure you might have.
DOJ Cases Involving VA Healthcare Fraud:
- A Colorado man who worked for a VA home health agency was convicted by a federal jury for his role in a VA healthcare fraud scheme. According to evidence presented at trial, the man was responsible for the intake of patients at a VA home health agency. Instead of insuring medical necessity of the patients for home health services, the man enrolled all patients in home healthcare regardless of their medical need. The man was paid a kickback in the form of cash for every procedure reimbursed for every patient he admitted to the home health agency. As a result of his conviction, the man faces up to 20 years in prison.
- A doctor in Virginia was indicted for healthcare fraud stemming from his alleged involvement in an up-coding scheme at a VA hospital. According to the indictment, the doctor was billing services as inpatient when these services should have been billed as outpatient. Inpatient services reimburse at a higher amount than outpatient services. If convicted, the doctor faces up to 10 years in prison.
- A Texas woman was indicted for defrauding the Department of Veterans Affairs. According to the indictment, the woman, who is the wife of a veteran thus eligible for VA benefits, allegedly submitting falsified prescriptions for reimbursement to the VA in excess of $600,000. Since the prescriptions were fraudulent, the woman is alleged to have pocketed the $600,000 since she is accused of never actually paying for the prescriptions in the first place.
Oberheiden P.C. VA Healthcare Fraud Defense Attorneys
If you are being investigated for VA healthcare fraud charges, contact the attorneys of Oberheiden P.C. today.