Business owners can face fraud charges simply as a result of a lack of understanding of the routine processes that are unique to the business.
Medical doctors in highly specialized fields such as skin cancer removal may also become subjects of insurance fraud investigations, particularly due to controversies in the diagnosis and treatment of this delicate disease. In a recent case, despite strong allegations of routine fraudulent skin cell analysis, false findings of cancer, and unnecessary cancer removal procedures, a jury believed the defendant doctor’s defense against fraud, and decided to acquit.
Crime of Fraud
Fraud is a class of crimes that typically involve the intentional use of:
- Dishonest means
In fraud, the purpose of the deceit or dishonesty is to deprive another person of money, property, or a legal right. Unlike violent crimes where the injury to another is often physical, fraud is considered a white collar crime that is complex and often difficult to establish.
Skin Cancer Doctor Accused of Fraud
In the cited case involving a skin cancer doctor, the prosecution alleged that the defendant:
- Told patients that they had skin cancer when their skin cells were healthy, and then performed costly skin cancer removal procedures that were unnecessary, with the intention of defrauding insurance companies
- Made it appear that laboratory work on skin samples were performed by the defendant when he allegedly outsourced the skin cell analysis at a much lower cost, claiming from the insurance companies the higher professional fees as if the defendant conducted the lab work himself
- Engaged staff members who were allegedly unlicensed and unqualified to perform complex procedures such as skin grafts and suturing
Setting up a strong fraud defense strategy can be complicated, often requiring long hours of examination of voluminous records, documents, or transcripts of communications and employing expert witnesses to testify in favor of the defendant and cast doubt on the prosecution’s evidence.
In the cited case of insurance fraud, the defendant doctor presented experts who testified that skin cancer cells can have varying manifestations which can lead to differences in opinion when looking at the same slides of skin cells.
By showing the jury the possibility of differing yet honest opinions in skin cell analysis, the intricacies of insurance claim forms, and the necessity of conducting more effective but more expensive skin cancer removal procedures, the defendant was acquitted of all 41 charges of fraud.
In Washington, D.C., the experienced litigators at Lotze Mosley, LLP have years of proven experience in a wide range of cases alleging fraud. We are prepared to investigate every angle, engage experts, and assert strong fraud defenses for you in court.
We invite you to call us today at (202) 393-0535 to schedule a free initial consultation with one of our attorneys.