Over 30 Years Focused on Federal Criminal Defense

bHealth care fraud investigations and prosecutions have exploded in recent years, particularly since the passage of the Affordable Care Act in 2010. Spearheaded by the Department of Health and Human Services, Office of Inspector General (OIG), the Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI), these investigations of alleged violations of the various federal health care fraud statutes can result in indictment, incarceration, fines and exclusion from participation in a Federal health care program such as Medicare and Medicaid.

Allegations of health care fraud can be leveled against a health care practitioner or provider by a company which provides private health care plans, such as Blue Cross or Aetna, or a federally funded health care plan, such as Medicare and Medicaid. Companies that provide private health care plans have their own anti-fraud units which investigate allegations of fraud. These investigations may result in a civil suit filed by the private company against the practitioner/provider to recoup the alleged fraudulent payments. Although private health care companies can refer allegations of fraud to law enforcement agencies for criminal investigation, private companies cannot file criminal charges against the health care practitioner; only a federal or a state prosecutor can file criminal charges.

Mark S. Greenberg devotes his practice to representing small health care practitioners and providers who are under investigation by federal and state law enforcement agencies for health care fraud offenses. Although some of these investigations may arise from referrals from private health care companies, the vast majority of the investigations involve allegations of fraudulent reimbursement claims for services and items which are submitted to Medicare and Medicaid which are government, not private, health care plans.

The health care practitioners Mr. Greenberg represents include physicians, pharmacists, renal dialysis centers, home health care providers, hospice providers, durable medical equipment providers, ambulance service providers and mental health care providers. These providers can be investigated for any number of reasons, including:

  • billing Medicare or Medicaid for services which were not medically necessary or provided
  • upcoding, which is billing Medicare or Medicaid for a service or item that has a higher reimbursement rate than the service or item actually rendered
  • using or creating false documents to support claims of medical necessity
  • submitting claims for non-emergency ambulance transportation that is not medically necessary or properly documented
  • billing Medicare or Medicaid for home health care or hospice care to individuals who do not qualify for these services under Medicare regulations
  • providing or receiving monetary or non-monetary remuneration for patient referrals or product use
  • dispensing controlled substances, including oxycodone, for reasons others than medical necessity.

Medical Health Fraud Blog

In his blog, Mark Greenberg discusses investigations conducted by OIG, FBI and DOJ to inform the health care provider of what practices not to engage in. Because of the complicated rules and regulations governing the health care in this country, health care providers can make mistakes.

Learn what not to do, but if they accuse you of doing it, call Mark Greenberg at 267-253-7933.

Mark S. Greenberg is an experienced Philadelphia criminal defense attorney. Over the course of his 30+ year career, Mr. Greenberg has defended thousands of clients in state and federal criminal court in Pennsylvania, New Jersey and Delaware.

Mr. Greenberg’s practice focuses exclusively on representing clients who have been charged with or are under investigation for federal offenses. He provides skilled legal representation in negotiations, trials and appeals, as well as advising clients on grand jury proceedings.

In cases ranging from federal fraud crimes, and federal appeals, Mr. Greenberg has built a track record of success.

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Mr. Greenberg understands the gravity of your situation. He is committed to providing you with the same degree of personalized service he would expect to receive if circumstances were reversed.

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