What are the Three Types of Defense Attorneys?

 There are three types of defense attorneys that can assist providers with health care fraud investigations in varying circumstances. These are:

• Civil Defense Attorneys – Civil defense attorneys represent health care providers in fraud matters involving insurance companies, benefit managers, and other private parties.
• State Defense Attorneys – State defense attorneys represent health care providers in matters involving state agencies such as state attorney general’s offices and Medicaid Fraud Control Units (MFCUs).
• Federal Defense Attorneys – Federal defense attorneys represent health care providers in matters involving Medicare, Tricare, and the DOL and VA health care benefit programs. This includes investigations as well as civil and criminal law enforcement cases.

Burden of Proof

When an individual is accused of healthcare fraud, the government has to prove that the defendant engaged in a scheme to steal from a healthcare program, such as Medicare, DOL, Medicaid, Tricare, another government insurance program or a private insurance program.

As seen, healthcare fraud is a generic term that encompasses a variety of conduct designed to illegally obtain a financial benefit of a provider to the detriment of the state or federal government. The following list is not exclusive, but it summarizes some of the most common fraud examples.

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