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The 3 Questions Important to Every Healthcare Fraud Defense

Healthcare fraud is a crime that is becoming more common, and if you look at the industry, it’s almost understandable. When you can’t call a hospital and get a straight answer on how much a procedure costs, you’ve got an environment that lends itself to fraudulent activity.

One case recently hit pretty close to home. A group of conspirators — one of them a Texas man — posed as Cerner and defrauded multiple victims out of millions of dollars. Here’s how it went down.

The Cerner Ruse

Becker’s Hospital Review reports that a group of individuals — among them Suresh Mitta, Albert Davis, and four other conspirators — “exploited Cerner’s reputation in the healthcare industry to manipulate business transactions and court proceedings for the conspirators’ benefit.” The incidents happened between Aug. 25, 2008, and Feb. 19, 2015. Several lost millions.

The Dallas Medical Center was named as one of the victims. Fake Cerner “attempted to sell a purported newly developed MRI system” to the hospital. They created fake email accounts for cardiologists in the Dallas area to increase the demand. The DMC didn’t check into the legitimacy good enough and ended up paying out $1 million for equipment it never received.

It was a perfect scheme until it wasn’t. As it turns out, not delivering on a $1 million payout is the sort of thing your customers notice. All parties now face charges. But who knew what? That’s the question where a defense strategy for something like this would begin.

Ignorance or Intent?

According to the site, the conspirators created a fake Cerner business, bank account, internet domain, and went to the trouble of leasing virtual office space in Kansas City, Mo. Furthermore, “They fabricated documents, price quotes, agreements, and invoices that appeared to be legitimate Cerner documents. They also developed fake Cerner employees, as well as fake physicians and respected leaders to support the counterfeit business and its products.”

In a case like this one, guilt is pretty clear at the top of the food chain. But hypothetically speaking, if you were one of the low-level conspirators, it’s possible that criminal activity like this could go on under your nose without you knowing it, all the while you are facilitating it. The questions you’ve got to have good answers to in this situation (or any fraud charge, for that matter):

  • How much did you know?
  • When did you know it?
  • What did you do after you found it out?

Healthcare Fraud Defenses Demand Experience

If you have been caught up in a healthcare fraud scheme and you need the knowledge of an experienced attorney, John Teakell’s number is the one you should be calling. You also can reach him online or at his Dallas office. An outcome cannot be guaranteed, but you can rest easier knowing that you will get the very best healthcare fraud defense possible to your situation.

Have a challenging case? Get a free consultation by our experts today!