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Defendants face aggressive prosecutorial efforts in health care fraud cases

According to new data by the Institute of Medicine, 30 cents are wasted or misused for every dollar spent on health care in America. In total, that amounts to roughly $750 billion per year. The analysis, base on 2009 data, shows that $210 billion is spent every year on unnecessary services and $130 billion is spent on inefficiently delivered services.

In addition to this, roughly $75 billion per year is lost to health care fraud, a category that includes health insurance fraud, drug fraud and medical fraud. Health insurance fraud, occurs when either a company or individual defrauds an insurer or government health care program. Programs like Medicaid and Medicare are plagued by such schemes.

According to the Centers for Medicare and Medicaid Services, up to $98 billion was lost to fraud and abuse in 2011. Because of the great amount of abuse in this area, the Obama administration has vowed to fight Medicare fraud and abuse very purposefully. The Affordable Care Act, for instance, includes provisions for more coordinated law enforcement efforts, increase standards for medical providers and the use of technology to better identify erroneous and fraudulent billing patterns.

There is no doubt that those charged with health care fraud are up against aggressive prosecution. Health care fraud, being a federal charge, can take daunting to face, and it is critical that defendants seek out an experienced attorney. The goal of defense will be to protect the defendant's rights and to ensure that prosecutors are held to their full burden of proof.

If a defendant is proactive in building a defense, it is often easier to steer the case in a favorable direction. Charges may not be able to be dismissed, but they may be minimized. In any case, a good defense attorney will do everything in their power to ensure the best possible outcome in the case/

Source: NY Times, "As Medicare Fraud Evolves, Vigilance Is Required," Walecia Konrad, September 11, 2012

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