Will I Go to Jail if Convicted of Healthcare Fraud?
California Healthcare fraud is often called Medicare, insurance, and medical billing fraud. Over the past several years, the number of healthcare fraud allegations has substantially increased.
Most patients will pay for their health care services through a private insurance company or a government medical insurance program, which is often a complex system that has become a prime target for fraud.
Further, confusing procedures in medical billing also create an opportunity for innocent, honest people to face accusations of healthcare fraud when it was just an honest mistake.
Many healthcare fraud cases in California are directly related to government programs like Medi-Cal, which is primarily used to assist low-income and elderly patients.
Further, there are some situations where healthcare fraud is charged under the federal statute of 18 U.S.C. § 1347, which generally involves substantial losses.
To give readers more important information about healthcare fraud, our Los Angeles criminal defense lawyers are reviewing the law below,
What are the Different Types of Healthcare Fraud?
There are many different ways to violate the laws on healthcare fraud, but the most common forms include the following:
- submit billing for services that a patient never received;
- submit billing for more expensive services than received;
- submit duplicate billing for the same medical procedure;
- submit false or fraudulent claims;
- document preparation in support of a fraudulent claim;
California Penal Code 550 PC is the common statute used by prosecutors to file charges when someone submits a claim for health care services or procedures that were not actually received by the person named on the claim.
Healthcare fraud under Penal Code 550 PC also occurs when there are multiple claims for the same procedure, known as “double billing,” the insurance provider.
Typically, defendants in healthcare fraud cases are the actual providers, such as doctors, nurses, therapists, and clinics, but they can also include medical secretaries.
What Factors Must Be Proven for a Conviction?
To convict someone of healthcare fraud, the prosecutor has to prove all the elements of the crime, including the following:
You knew the claim was false
It seems that you knew the claim you were submitting was fraudulent or duplicate or that the documents you prepared were made with the intent to submit a false claim.
You had an intent to defraud
The prosecutor must also show that you had a specific intent to defraud the medical insurance company or program.
If they can't prove this crucial element beyond a reasonable doubt, you can probably avoid a conviction. Intent is the primary element in all fraud-related crimes in California.
What are the Penalties?
If convicted of healthcare, the penalties are often severe but will depend on whether the case is a misdemeanor or felony.
Cases involving less than $950 are considered a misdemeanor and can be punished by:
- up to six months in a county jail,
- a maximum fine of $1000 fine, or both.
Any fraud exceeding $950 can be filed as a misdemeanor or felony, called a “wobbler.” If you are convicted of felony healthcare fraud, the penalties include the following:
- two, three, or five years in a county jail,
- probation with up to one year in county jail,
- fines up to $50,000 or double the amount of the fraud itself.
A healthcare professional defendant will normally face an experienced license suspension or revocation.
Why Will Healthcare Fraud Typically Land You in Prison?
The reason that most people who commit healthcare fraud land in prison is because the feds usually grab these cases under 18 U.S.C. § 1347 or a similar statute
I've noticed that Los Angeles has a special investigative unit out of Long Beach that handles these cases at the federal level.
So, if the feds grab you in a healthcare fraud case, it usually involves large numbers of people taking money from Medicare or other government sources. It involves doctors, patients, and people working in the medical community.
Suppose the feds end up grabbing the case. In that case, I can tell you from the experience of almost 30 years handling federal cases for healthcare fraud that the person is usually looking at serving in federal prison, and they'll usually serve it at 85% of whatever time they get.
What is My Best Chance at Avoiding Prison Time?
Other unique circumstances can cause the case not to be filed federally.
Sometimes, it will be filed at the state level, and then you have a much better chance of not going to prison, especially if:
- you have no criminal record,
- you were able to pay whatever money back the government has lost and
- you have other mitigating factors that can be given to the prosecutor and judge.
So, you can see that one crucial initial factor in avoiding prison is to prevent the case from being filed at the federal level.
What are the Best Defense Strategies to Fight Healthcare Fraud Allegations?
Step number one: If you're being investigated for or charged with healthcare fraud, you've got a case pending—pick up the phone.
Could you make the call? I've been doing this for almost 30 years. We'll have you come to the office. Everything you say is protected by the attorney/client privilege.
We'll discuss exactly your involvement and exposure and some strategies we can use to help put you in a better position.
Sometimes, you're innocent. Sometimes, you work in a medical facility and somehow get involved in a healthcare fraud situation as part of your job.
If that's true, there are ways to protect yourself. You can help yourself, but your best bet is to have an attorney who can defend you.
The attorney will be able to talk to the government on your behalf, and an attorney will be able to figure out the best move for you based on your circumstances.
When you hire an attorney like me, my goal is to see that either charges are filed against you or the charges are dismissed against you if they've already been filed once I get on the case. If the government has the evidence to prove the case against you, I'll try to mitigate the situation.
- First, you've got to get into an attorney;
- Next, you have to tell the attorney the truth about what happened, and
- You have to develop a strategy moving forward for handling your case.
You've never defended a healthcare fraud case before; I have. I'll be the one who helps you make the right moves and say the right things. I'll be the one dealing with law enforcement, the one dealing with the prosecutors, and the one dealing with the judge in the end.
Pick up the phone now. Make the call. Ask for a meeting with Ron Hedding. I've been handling these cases for a long time. I know what it takes to be successful, and I know what it takes to get you out of the criminal justice system as quickly as possible.
Hedding law firm is located in Los Angeles County. We offer a free case consultation to review the specific details of what happened and discuss the potential legal options moving forward for the best chance at a favorable outcome. We have a record of success in state or federal healthcare fraud cases.
