The crime of healthcare fraud is a complex legal issue that typically involves large amounts of money and mountains of paperwork. If you have been accused of this crime, defending yourself in court can be difficult. Thankfully, a skilled healthcare fraud attorney might be able to help.

If you are the target of an investigation into healthcare fraud, now is the time to mount your defense. Every day that goes by is another day that the government has to build a case against you. By hiring a Columbia healthcare fraud lawyer, you could give yourself the ability to fight back against these charges.

What Constitutes Healthcare Fraud?

There are numerous activities that could be considered healthcare fraud under state or federal law. Each of these allegations can differ significantly, but the underlying theme involves wrongfully-obtained compensation through Medicaid or Medicare. A Columbia healthcare fraud attorney could assist with the defense against the following allegations:


In general, kickbacks involve one party to a transaction sharing the profits with the other party as a reward for doing business with them. In the healthcare facility, this often involves doctors referring patients to certain facilities or other healthcare professionals in exchange for money or anything of value.

Unneeded Medical Procedures

Another common example of healthcare fraud occurs unbeknownst to the patient. Often, doctors will perform medical procedures that were unnecessary, as an excuse to seek reimbursement. Any procedure that is unnecessary or unrelated to a patient’s condition could be considered fraudulent.

Fraudulent Billing

Fraudulent billing practices can also lead to criminal charges. These practices can take different forms. For example, billing for procedures that never occur is one example, while billing twice for the same procedure is another example. Charges could also stem from a doctor billing for a procedure separately and then again in a bundle with other procedures.


Upcoding is the term used when medical providers perform one procedure but then bill for the most expensive form of that procedure instead. The end result is a medical provider being compensated for more than what the actual procedure was worth. Upcoding is most common in cases where Medicare and Medicaid are responsible for paying the medical bills.

Who Investigates Healthcare Fraud?

For the most part, charges of healthcare fraud are pursued on the federal level. In fact, there are multiple divisions of the federal government that are tasked with overseeing these fraud investigations.

That is not to say that state authorities will not investigate healthcare fraud. While healthcare fraud is a federal offense, state laws also prohibit these activities. Should the federal government choose not to move forward with a prosecution, state or local law enforcement could look further into allegations of healthcare fraud.

Regardless of who is tasked with investigating these cases, the right attorney could help the accused fight back. There are numerous viable defenses when it comes to charges of healthcare fraud, and a Columbia attorney could evaluate each of them in any given case.

Talk to a Columbia Healthcare Fraud Attorney Today

A conviction for healthcare fraud could have life-changing consequences for you and your loved ones. Both state and federal convictions have the potential to lead to time behind bars and costly fines, among other consequences. Fortunately, you do not have to defend yourself on your own. Call a Columbia healthcare fraud lawyer to get started on your defense

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