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How Does The Government Prove Intent In Healthcare Fraud?

Healthcare fraud is a specific intent crime, meaning the government cannot secure a conviction simply by proving that false claims were submitted. Prosecutors must demonstrate that the defendant knowingly and willfully acted to defraud — a standard that requires getting inside the mind of the accused. Here is how they do it. Intent Under 18 [...]

Healthcare Fraud Defenses Guide

Legal defenses for healthcare fraud charges challenge allegations of fraudulent billing for financial gain. Healthcare fraud prosecutions under statutes such as the False Claims Act, Anti-Kickback Statute, and Stark Law carry severe penalties. Providers can face prison, exclusion from Medicare and Medicaid, and the permanent loss of professional licensure. Mounting a strong defense is imperative. Lowther [...]

What Happens in a Federal Health Care Fraud Case: A Guide for Providers

For those facing healthcare fraud allegations, this complete guide to healthcare fraud defense explains the laws, the evidence collection process and the available defense options. [...]

MAC Audits vs. UPIC Audits: What Medical Professionals Need to Know

Medicare’s program integrity framework relies on multiple layers of auditing activity. For most providers, the two audit types most likely to affect day-to-day operations are those conducted by Medicare Administrative Contractors (MACs) and Unified Program Integrity Contractors (UPICs). Though both are federal audit mechanisms operating under the authority of the Centers for Medicare & Medicaid [...]

What Is a UPIC Audit? Process, Triggers & How to Respond

A UPIC audit is an investigation focused on uncovering healthcare fraud. From handling unannounced site visits to understanding the dangers of statistical extrapolation, this guide details the critical steps you must take to protect your practice from payment suspensions and federal prosecution. [...]

What is the Line Between Medical Billing Errors and Healthcare Fraud?

Learn how federal law separates medical billing from from simple billing errors. You'll discover the role of intent and the steps you can take to protect your healthcare practice during billing fraud investigations. [...]