Health care fraud is often called insurance fraud, medical billing fraud, Medicare fraud, or Medi-Cal Fraud. The numbers of health care fraud allegations and prosecutions have risen sharply over the past decade.
The procedure for processing health care payments is usually complex, which opens the door for someone to commit fraud. Vast numbers of health care fraud cases are related to government programs such as Medi-Cal and Medicaid, designed to help low-income and elderly patients.
There are some situations where a health care fraud is charged under the federal statute 18 U.S.C. § 1347, which generally involves significant financial losses.
If you're being charged with health care fraud in today's day and age, you need the best criminal defense attorney you can find. The reason why is because many of the prosecutors dealing with these cases are trying to send the offenders to prison.
They're trying to put a mark on their record that will last the rest of their life, and they're not messing around. Los Angeles criminal defense attorneys will take a closer look below.
What Are the Basis Types of Health Care Fraud?
Health care fraud is usually committed in several different ways, including:
- billing for services never received by the patient;
- submitting false or fraudulent insurance claims;
- billing for more expensive services than a patient received;
- submitting duplicate billing claims for the same procedure;
- preparing a document to support a fraudulent claim;
California Penal Code 550 PC prohibits submitting a claim for health care services or procedures that the person named on the claim was not received.
Simply put, submitting a claim to a health insurance company for services that were never delivered is a significant type of health care fraud.
Another type is when someone submits multiple claims for the same medical service, commonly known as “double billing” the insurance provider.
Usually, health care providers are charged, such as doctors and therapists, but could also include records clerks and medical secretaries.
To be convicted of health care fraud, the prosecutor has to prove two crucial factors known as the “elements of the crime:”
- Defendant knew the claim was false or fraudulent, and
- Defendant had an intent to defraud.
Fraud over $950 can be charged as a misdemeanor or felony, called a “wobbler.” If convicted of felony health care fraud, the penalties include:
- two, three, or five-year sentences in jail,
- probation with up to one year in jail,
- up to $50,000 in fines or double the amount of the fraud itself.
Health care professionals could have their licenses suspended or revoked.
Mitigation of Health Care Fraud Cases
To properly defend yourself, to either prove that you're not guilty or mitigate things down if you are guilty, but you shouldn't be facing a prison sentence, you're going to need the best criminal defense attorney you can find.
That's where I come in. This is all I have been doing for 30 years. I started my pursuit of law to help people just like you in 1990. I worked for a Superior Court Judge as his research attorney to see how judges deal with healthcare fraud cases and criminal cases in general.
I worked for the District Attorney's office in East Los Angeles in the early 1990s to see how prosecutors prepare these cases, what type of a mentality they have, how the police deal with these types of cases.
And then, in 1994, I opened my criminal defense practice, and I've been handling healthcare fraud cases ever since.
I understand all of the angles. I know the angles when they go after doctors. I know the angles when they go after employees, and I know the angles when they go after the peripheral people related to healthcare fraud cases. Many aspects can present themselves in a healthcare fraud case.
Initial Defense Strategy Meeting
The first step would be to set up a meeting with me. We'll sit down in my office with the protection of the attorney/client privilege.
So, even if you don't end up hiring me, you can feel comfortable speaking freely about the case so that I can understand what evidence they have against you. Also, what you did and didn't do, I can help you evaluate the best move in the future.
Whenever you have an issue in life and try to figure out what to do, the first step is to get all the facts.
Sometimes people look at a situation, and they think they're doomed, but they haven't even evaluated all of the facts. They haven't even looked at what they're facing and looked at what they're facing from a criminal defense standpoint.
How could somebody in your position charged or being investigated for healthcare fraud know what is about to come? You wouldn't unless you've been down this road before.
Determining How to Challenge the Case
Fortunately, for you, I have been down this road before. I know what's to come depending on the circumstances of your care. So, I'm going to gather information from you at the first meeting. We're going to talk about what you're facing.
Hopefully, I'm going to give you peace of mind, so you say, okay, here's what I'm facing, and then what are we going to do about it? How are we going to handle it? How are we going to attack the problem?
You can't just put your head down and do nothing. You've got to evaluate the facts. Then you've got to figure out the best options, you do it, and now you have the peace of mind to say okay, I see what I'm up against.
I know what I have to do, and I'm going to do it. I've hired the best criminal defense attorney in Ron Hedding. I'm going to let him go to work. I'm going to trust him. I'm going to provide him with straight, honest, accurate information.
I'm not going to omit anything when I talk to him because he's trying to help me. He has my best interests at heart, and I don't want him to be surprised by something I could have told him.
Now you understand what it will take to be successful in your healthcare fraud case. You know that I'm one of the best in Los Angeles. I'm here to help you.
Pick up the phone. Ask for a meeting with Ron Hedding of the Hedding Law Firm. I stand at the ready to help you. We are located in Los Angeles County and serve people throughout Southern California.