Medicare fraud is generally described as submitting false claims to any federal government healthcare program in order to acquire an unlawful payment.
It's is a serious federal crime that carries both criminal and civil penalties. It includes more than just the federal Medicare program, such as the Medicaid and federal workers' compensation.
If you are under a criminal investigation for Medicare fraud, it means you are suspected of violating a at least one federal statute, including:
- False Claims Act,
- Stark Law,
- Anti-Kickback Statute.
California healthcare providers are common targets of Medicare Fraud Strike Force prosecutions because of the huge amount of recipients on a federal healthcare program. Their primary responsibility is to monitor, investigate, and prosecute cases of Medicare fraud.
They are an investigative body of the federal government that employs prosecutors and experienced investigators from with numerous federal law enforcement agencies.
This includes the Federal Bureau of Investigation (FBI), Drug Enforcement Administration (DEA), Department of Justice (DOJ), Internal Revenue Service (IRS), Office of Inspector General, and others.
Common Reasons for Medicare Fraud Investigations
One of the most common reasons for the initiation of a Medicare fraud investigations in California deals with the billing for services.
Typically, it will start after the federal government is notified about billing errors that are potentially a fraudulent billing practice and request for reimbursements.
Specifically, these include excessive, unauthorized, excessive, or just false charges, which are normally a result of billing for:
- double billing,
- inflating charges and upcoding,
- unnecessary services,
- services that were never actually provided,
- medically unnecessary supplies,
- equipment or services that were never requested,
- certifying medically unnecessary supplies or services,
- providing or accepting kickbacks
The most common targets of a Medicare fraud investigation in California are:
- healthcare professionals,
- nursing homes,
- hospice care,
- DME providers,
- cancer treatment centers.
It should be noted, however, that any type of facility that a federal healthcare program submits claims for reimbursement can be the target of a Medicare fraud investigation.
Civil and Criminal Penalties for Medicare Fraud
Medicare fraud investigations include civil and criminal penalties. You or your business could be facing severe civil penalties, such as Treble damages, fines of up to $11,000 per false claim, lawyer fees, recoupment, and be excluded from making future federal healthcare program claims.
The criminal penalties for Medicare fraud in California include:
- 10 years in federal prison for each count,
- 20 years if the Medicare fraud resulted in serious bodily injury, and
- a life sentence if it caused a patient's death.
Further, there are massive fines and you will most likely face state disciplinary actions, such as a loss of a professional license, and loss of hospital privileges.
Why You Need Experienced Criminal Defense
A conviction for Medicare fraud in California will result in severe consequences, which is why you need to retain an experienced criminal lawyer, which will give you a much better chance at a favorable outcome.
Medicare fraud is a very common crime nowadays and it can raise itself in many different ways.
For example, somebody could be an employee at a doctor's office and that doctor's office could be cheating the government out of healthcare money and that employee could end up getting twisted up in it because their working for a boss.
Also, doctors can get twisted up in this where they're involve in committing Medicare fraud and the list goes on and on.
If you're being investigated for Medicare fraud, or your business is being investigated, you've come to the right place. I have been handling these cases since their inception.
I've been a Los Angeles criminal defense attorney now since the early 1990s, defending Medicare fraud type of offenses. And nowadays, depending on the:
- amount of money involved,
- who's involved,
- what agency,
- the amount of loss that's involved,
- whether it's a huge amount,
- the amount of sophistication.
These above are the factors that's going to dictate whether the federal government prosecutes the case or whether the state government prosecutes the case.
Fortunately, you've landed on a website where I'm familiar with defending both state and federal crimes.
I know what it takes to defend these types of cases, and sometimes people get swept up in the huge net of a multi-million-dollar scam going on involving Medicare fraud.
Maybe they're either not as involved as other people or maybe they're not involved at all — maybe they're simply being used by the main culprits. Or, maybe they're the doctor, the office manager.
There's a whole host of different parts of these Medicare fraud scams, and if you're charged with or being investigated for one of these types of cases, you need a defense attorney immediately.
Developing a Defense Strategy for Medicare Fraud
Pick up the phone and ask for a meeting with Ron Hedding. So, when we sit down, we're going to talk about exactly what it's going to take to get you the best result.
First, we have to decide if it's a case that you can defend or if it's a case where you're going to have to accept some sort of culpability.
Once we have that decision made, then we have to set our goals for the case — our goals for your future — as it realistically relates to what you're charged with, what you did, how much loss you were involved with, how many victims were involved and the list goes on and on.
I'm prepared to help you. I've handled thousands of these types of offenses to a successful result. If you're charged with Medicare fraud in Los Angeles, California, you need to come up with a game plan.
You can't just twist in the wind, bury your head in the sand and hope for the best. You can't rely on somebody else to get you what you need as far as a result goes.
When there's a bunch of potential targets and defendants in these cases, they're going to do what it takes to help themselves; you need to do the same.
Hire a great attorney and give them all of the information. Don't leave out facts that you don't want them to hear.
Tell them everything so they can give you a realistic idea of what you're facing and what you can do to help yourself and what you can do to help them.
I'm prepared to help you. You just need to take the first step, make the phone call and set up a meeting.
Hedding Law Firm is located in Los Angeles County at 16000 Ventura Blvd #1208 Encino, CA 91436.
Contact our office for a free case evaluation at (213) 542-0979.