Healthcare Fraud Defense Attorney Los Angeles

An investigation into allegations of healthcare fraud can paralyze a healthcare provider—doctor, dentist, nurses—and any other providers such as pharmacists, ambulance companies, medical testing facilities, equipment suppliers, group homes, residential facilities, and hospitals. Any institution or corporation that relies on reimbursement from government agencies or insurance companies can be targeted. Most investigations begin with a call to a tip line, a whistleblower, or a patient complaint.

Unfortunately, if caught up in an investigation for healthcare fraud, ordinary and unintentional mistakes can escalate into a civil liability. Intentional fraud can result in criminal prosecutions. No matter what, you need the services of skilled and experienced healthcare fraud defense attorneys to protect you, your business, and your future livelihood.

Retaining skilled and experienced counsel early in a healthcare fraud investigation is necessary to preserve your options and protect your rights as a provider or vendor. As soon as you learn that you might be the target of such an investigation, you should contact RP Criminal Defense Law to schedule a consultation. Our Los Angeles based healthcare defense attorneys assess the strength of the government’s case and guide you through the investigation and ensuing criminal prosecution or civil suit. We are conveniently located in Encino and Ontario. RP Criminal Defense Law provides aggressive individualized representation backed by experience and a thorough understanding of all aspects of healthcare fraud litigation, both civil and criminal.

What is Healthcare Fraud?

Healthcare fraud covers a broad range of offenses, the common theme of which is obtaining funds from Medicare, Medicaid, Tricare, or insurance companies through improper means. Government investigators look for patterns among the claims for reimbursement from these sources to discern whether there are any markers of fraud. In addition, businesses are prohibited from providing or receiving unlawful kickbacks or referral fees.

Even law firms can get caught up in a healthcare fraud investigation if allegations of kickbacks or creating fictitious injury claims are made.

These are some examples of what constitutes healthcare fraud:

  • Billing insurance companies for healthcare services that were never performed
  • Double billing
  • Entering a code for a more expensive procedure than performed
  • Falsifying medical records
  • Prescribing and providing unnecessary procedures
  • Prescribing unnecessary medication, especially opioids and other addictive medicines
  • Requesting excessive and unnecessary patient testing

Multiple governmental agencies have jurisdiction to initiate investigations into claims of healthcare fraud. Depending on whether there is evidence of civil or criminal liability, the Department of Justice, Drug Enforcement Administration, or Office of Inspector General might become involved. Their subpoena power is extensive and, consequently, burdensome.

Medicare & Medi-Cal Fraud

The federal government investigates charges of Medicare fraud and California addresses allegations of Medi-Cal fraud.

The U.S. Department of Health and Human Services, Center for Medicare and Medicaid Services has an aggressive audit policy that can drag medical providers into a whirlpool of compliance demands. As soon as you receive notice of any investigation, you should consult with an experienced Los Angeles Healthcare Fraud attorney to confine the scope of any investigation, preserve your rights, conserve your resources, and allow you to continue to do business.

Federal healthcare fraud investigations can involve several federal statutes or administrative regulations, carrying both criminal and civil penalties:

  • False Claims Act
  • Anti-Kickback Statute
  • Stark Law
  • Controlled Substances Act
  • Federal Healthcare Fraud Act
  • Program Billing Procedures
  • Department of Justice Mandates

An investigation into California healthcare fraud usually involves a violation of the Insurance Code and Welfare and Institutions Code for making a false material statement to either obtain or deny insurance benefits. Such statements, if intentionally fraudulent, can reach criminal liability and penalties.

Effective medical care fraud defense might confine the scope of an investigation and therefore control the extent of the inquiry. Through successful negotiations, these investigations can often result in settlements and a review of practices to prevent future problems. Your personal and business future is at risk, so it is important to confer with an experienced Los Angeles Healthcare Fraud Lawyer as soon as possible.

Healthcare Fraud Penalties

A conviction for civil or criminal healthcare fraud in either federal or California courts can bring significant penalties, including fines, incarceration, and bans on future business with the state or federal governments. Civil penalties of up to $10,000 can be imposed per transaction, meaning that 10 or 20 suspect claims can result in $100,000 or $200,000 fines.

Criminal convictions carry possible prison sentences along with fines and bans on future business.

  • Fines up to $250,000 per offense
  • Forfeiture of assets
  • Job loss
  • Loss of board certification
  • Loss of professional licenses
  • Prison time, as long as 20 years for maximum sentences
  • Prohibition on billing any federal entity for a period of years up to life
  • Restitution

Legal Defense for Medical Care Fraud Charges

Consulting an experienced healthcare fraud defense lawyer early in an investigation offers the most options to defend your case. First, early intervention might confine the scope of the investigation, might move from a criminal to a civil investigation and might result in settlement of claims without future bans on providing services for government or insurance reimbursement. The dividing line between civil and criminal liability is “intent” so getting a savvy Los Angeles healthcare fraud defense specialist involved early might prevent an investigation from leading to an indictment.

What defenses will work depends on the unique facts of your business. Only an experienced and thorough healthcare fraud defense lawyer knows how to review these kinds of files and billings, hire the right accountants and computer experts, and make sense of your system to show that there was no intended criminality.

Healthcare Fraud Lawyer Serving Los Angeles & San Bernadino

Facing a California or federal investigation or prosecution for healthcare fraud can be expensive and disruptive. You deserve a fair assessment of the strength of the theory of liability, either civil or criminal, to determine how best to proceed. You also deserve representation that will bring skill and expertise to examining the subpoenas and investigatory requests, an independent investigation and financial audit to fully understand the weight of evidence, and the savvy one gets from years of experience representing businesses involved in the healthcare industry in the Los Angeles and San Bernadino areas.

Our offices are conveniently located in Encino and Ontario. Only seasoned healthcare fraud defense attorneys can realistically evaluate the evidence, the credibility of witnesses, and the predisposition of the investigators and, eventually, the judge assigned to the trial. Contact us today for your initial consultation. A $250 fee will be charged and credited to your account if RP Criminal Defense Law is retained.