California Healthcare fraud is often referred to as Medicare fraud, insurance fraud, and medical billing fraud. Over the past several years, there has been a substantial increase in the number of healthcare fraud allegations.
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 creates an opportunity for innocent honest people to face accusations of healthcare fraud when it was just an honest mistake.
A large number of healthcare fraud cases in the state of 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 a 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 literally many different ways to violate the laws on healthcare fraud, but the most common forms include the following:
- submit billing for services that were never received by a patient;
- submit billing for more expensive services than actually 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 was not actually received by the person who is named on the claim.
As noted, 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, therapist, clinics, but can also include medical secretaries.
What Factors Must Be Proven for a Conviction?
In order to convict someone of healthcare fraud, the prosecutor has to prove all the elements of the crime that include the following:
You knew the claim was false
It must be proven you actually knew the claim you were submitting was fraudulent, duplicate, or the documents you prepared were made with intent to submit a false claim.
You had an intent to defraud
The prosecutor must also show you had a specific intent to defraud the medical insurance company or insurance program.
If they can't prove this crucial element beyond a reasonable doubt, you will probably be able to 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 misdemeanors 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 either a misdemeanor or felony, called a “wobbler.” If you are convicted of felony health care fraud, the penalties include:
- 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 defendant who is a health care professional will normally face a professional 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 in Los Angeles, they've got a special investigative unity out of Long Beach that is handling these cases at the federal level.
So, if the feds grab you and it's a healthcare fraud case, that usually means it involves large numbers, taking money from Medicare or other government sources. It involves doctors, patients and people who work within the medical community.
If the feds end up grabbing the case, I can tell you from experience of almost 30 years handling federal cases for healthcare fraud, the person is usually looking at serving federal prison and they'll usually serve it at 85% of whatever time they get.
What is My Best Chance at Avoiding Prison Time?
There are other unique circumstances that 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 initial crucial factor to avoid prison is to avoid the case 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 healthcare fraud or you're being charged with healthcare fraud, you've got a case pending — pick up the phone.
Make the call. I've been doing this almost 30 years. We'll have you come in the office. Everything you say is protected by the attorney/client privilege.
We'll talk about exactly what your involvement was, what your exposure is and some of the strategies that we can use to help put you in a better position.
Sometimes you're innocent. Sometimes you work in a medical facility and somehow you've gotten wrapped up in a healthcare fraud situation as part of your job.
There's ways that if that's true, you can protect yourself. You can help yourself, but your best bet is to have an attorney and an attorney is going to be able to defend you.
The attorney is going to be able to talk to the government on your behalf and an attorney is going to be able to figure out what the best move is 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 or I'm going to try to mitigate the situation if the government has the evidence to prove the case against you.
- 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 get a strategy moving forward on how you're going to handle your case.
Criminal Defense for Healthcare Fraud
You've obviously, never defended a healthcare fraud case before; I have. I'm going to be the one who's going to help you make the right moves and say the right things.
I'll be the one who deals with law enforcement. I'll be the one who deals with the prosecutors and I'll be the one who deals 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 fast as possible.
Hedding law firm is located in Los Angeles County and we offer a free case consultation to review the specific details of what happened and to discuss the potential legal options moving forward for the best chance at a favorable outcome. We have a record of success on state or federal level healthcare fraud cases.
