Fraudulent Liability Claims (Health Insurance Fraud)

Submitting a fraudulent claim for bodily injury or a false claim for a health problem is a crime. This is considered by federal law to be a white collar crime, meaning a crime where no threat of injury or bodily harm is involved.

The Federal Bureau of Investigation (FBI) defines white collar crimes as illegal acts that "are characterized by deceit, concealment or violation of trust and which are not dependent upon the application or threat of physical force or violence."

At times, however, a person is wrongfully charged with submitting a fraudulent claim. If this is your situation and you believe you are innocent or not guilty of the charges against you, you need to contact defense attorney David Dudley as soon as possible. Mr. Dudley has a long history of helping people wrongly accused of committing white collar crimes. He also represents those who actually committed the crime, and fights to get their charges reduced if not dropped completely.

Mr. Dudley has decades of experience defending the most complex and involved criminal cases. He is a well-known defense attorney with a reputation for success. Mr. Dudley practices both state and federal law. He has been in practice since he graduated in 1984 from Harvard Law School.

Types of Fraudulent Liability Charges

Fraudulent liability charges can include:

  • Medicare and Medicaid fraud
  • Private health insurance fraud
  • Real Estate Fraud
  • Mortgage Fraud
  • Violating the Civil Monetary Penalties Law
  • Kickback fraud

This law authorizes the Secretary of Health and Human Services to impose civil monetary penalties, an assessment and program exclusion for a variety of forms of fraud and abuse involving the Medicare and Medicaid programs.

Penalties, if you are found guilty, range from $2,000 to $100,000. These monetary sanctions are often much greater than the damage the government actually sustains. The standard requirement for a finding of guilt also is lower. The Inspector General must only prove liability by "a preponderance of the evidence" rather than by the stricter "beyond a reasonable doubt" requirement.

Health Insurance Fraud: Selected Results

  • U.S. v. N.S.: A medical doctor was indicted federally for overcharging a government health insurance agency by more than $100,000 for services he had provided to several patients. Although the defendant was convicted at trial, he received a sentence of only 24 months for his misconduct.
  • P. v. E.D.: While working in the accounting department of medical clinic which provided free and discounted services to the poor, the defendant embezzled $1,200,000. Consequently, the district attorney charged her with several felony fraud counts. After producing a psychiatric report and other documents which demonstrated that the defendant engaged in the unlawful conduct only to support a massive gambling addiction, the defense was able to obtain a disposition under which she received a prison term of only four years.
  • U.S. v. R.S.: Paying retail clerks and medical receptionists to scan the credit cards of customers, the defendant used the information obtained to manufacture counterfeit credit cards. When he was indicted federally, the government claimed that he had caused losses of over $1,000,000 to cardholders and financial institutions. After reaching a plea bargain which left open the issue of aggregate loss, Attorney Dudley convinced the court to apply a reasonable doubt standard to the government's claim of how much money his conduct caused victims, even though the court was not legally required to use such a high standard. Applying that standard of proof, the court found that the government could only demonstrate losses of $420,000. The court then departed slightly downward from the resulting guideline range to impose a sentence of 46 months, 41 months lower than the government's recommendation.
  • U.S. v. C.V.: The defendant was the office manager for several health clinics which allegedly defrauded the government and several health insurance companies of over $42,000,000 dollars. The United States Attorney named her as a principal conspirator in a multi-count indictment. After litigating numerous pre-trial motions, the defense eventually negotiated a disposition for approximately 22 months of TIME SERVED.