California Medicare Fraud Defense Lawyer

Experienced Health Care Law Defense Team Serving all of California

The Criminal Defense Firm is a health care law defense firm that deals with cases in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our diverse group of attorneys has both the educational background and relevant experience necessary for your case and includes the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, and former lead prosecutors of the elite Medicare Fraud Strike Force. We serve clients in the state of California and the surrounding areas.

Doctors, nurses, health care facilities, and related businesses in California have an astronomical chance of being investigated for Medicare fraud. If you’ve been notified of an investigation, you need a legal team offering health care fraud defense. The Criminal Defense Firm serves California health care providers, facilities, and businesses.

Medicare Fraud

Medicare fraud is a federal offense that carries both civil and criminal ramifications. It also doesn’t just cover Medicare. It actually can involve any federal health care program: Medicaid, Tricare, and federal workers compensation programs are included. Medicare fraud is defined as the submission of false claims to any federal government health care program in order to receive an illegal payment on the false claim(s). If you are accused of committing Medicare fraud, you’re being accused of violating at least one of the following laws:

• Stark Law (Physician Self-Referral Law)
• Anti-Kickback Statute
• False Claims Act
• Social Security Act
• U.S. Criminal law

In California, health care providers, businesses, and facilities face a higher risk of allegations because California has a large number of federal health care program beneficiaries. The government believes that since a higher number of claims are filed in California, there is a higher risk that fictitious claims are filed. Because of this, the federal government set up the Medicare Fraud Strike Force. Although they monitor, investigate, and prosecute Medicare fraud all over the United States, there are nine areas that are more closely scrutinized. California is one of those nine areas.

The Medicare Fraud Strike Force Team is made up of investigators and prosecutors from several federal agencies including the DEA, DOJ, DOD, FBI, IRS, the Office of Inspector General, and Department of Human Services. This list isn’t all-inclusive. There are often other federal agencies involved.

What’s the Most Common Cause of Investigations?

In California, many Medicare fraud investigations start because the Medicare Fraud Strike Force is alerted to billing errors. When mistakes are made by providers, entities, and facilities when billing the federal government, they are often deemed as fraudulent billing practices and reimbursement requests. The most common errors in California are:

• Billing for medically unnecessary supplies
• Billing for unnecessary services
• Billing for services that were never performed (referred to as phantom billing)
• Billing for equipment or services that were never ordered
• Certification for medically unnecessary supplies or services (including hospice care and medical devices)
• Inflating charges
• Double billing
• Upcoding
• Overuse of services or equipment
• Providing kickbacks
• Accepting kickbacks

In California, those persons or entities most commonly investigated include doctors, nurses, health care services, nursing homes, registered care facilities, hospitals, clinics, pharmacies, DME providers, labs, DNA centers, and cancer treatment centers.

Potential Civil and Criminal Penalties

Medicare fraud investigations are extremely serious. You, your practice, or your business could face civil and criminal penalties. You could receive one or more of the following civil penalties:

• Treble damages
• Payment of civil fines of up to $11,000 per false claim
• Recoupment requests
• Non-payment of future federal health care program claims
• Federal health care program exclusion
• Attorney fees

You may face one or more of the following criminal penalties:

• Criminal record
• Fines in the hundreds of thousands of dollars
• 10 years in federal prison for each count of Medicare fraud
• 20 years in federal prison if the Medicare fraud resulted in serious bodily injury
• A life sentence in federal prison if the Medicare fraud resulted in the patient’s death

Choosing the Right California Medicare Fraud Attorney Is Critical

If you have been notified that you’re being investigated for Medicare fraud, it is critical that you choose the right California defense attorney. Your chosen attorney should have the experience and the skills that you need to negotiate with the federal government during the investigation someone who is prepared to go to trial on your behalf.

There are state providers who may consider choosing a health care attorney to assist them during the Medicare fraud investigation. However, when there is an allegation of Medicare fraud, it is extremely likely that you’ll also be charged with federal crimes like tax evasion, wire fraud, mail fraud, or money laundering. A health care attorney may understand the nuances of health care law, but he or she may not have the training or experience you need to assist you with a defense for the federal allegations. A health care attorney may not be ready to negotiate with the federal government or face federal prosecutors during trial.

Individuals and businesses that discover they are facing criminal prosecution because of Medicare fraud often contact a medicare fraud defense attorney. However, criminal defense attorneys don’t usually have the necessary knowledge of health care law. Many aren’t experienced in federal crimes. You simply will not have the time to teach a criminal defense attorney the intricacies of billing, coding, and medical utilization rules.

Look for ahealth care fraud defense attorney. Look for these four key qualifications:

1. A proven track record of success in Medicare fraud cases
2. Industry knowledge
3. Deep familiarity with health care laws and their exceptions
4. Litigation and trial experience

When you locate firms matching the above criteria, you should ask these three cases to ensure that your options have the experience that you need:

1. How many Medicare fraud cases have you handled during your career in law?
2. How many of those cases resulted in no civil or criminal charges or in dismissals for your clients?
3. How many Medicare fraud cases did you try in court?

Proven Medicare Fraud Defense Strategies in California

The Criminal Defense Firm serves California health care practitioners, businesses, and entities. We use our three core principles in each case in order to develop a strategic defense. Many of the members of our Health Care Fraud Defense Team have previous experience as senior federal health care prosecutors with the Department of Justice. Having experience in both prosecution and defense provides valuable insight for each and every case. Our primary goal is to resolve the investigation and reduce the risk of criminal charges. Here are our three core strategies:

Early intervention on behalf of our clients. One of the very best strategies that we use is early intervention with the federal government on behalf of our clients. We know that the longer the federal government has to investigate you without interruption, the more likely it is that you’ll face federal criminal charges. We get in contact with investigating agencies right away to the questions that you have. Usually within hours, we can get answers to questions like:

• What is the investigation about?
• What prompted the investigation?
• Is this civil or criminal?
• Which federal agencies are involved in the investigation?
• Who all is being investigated?
• How can the matter be resolved?

Lack of evidence. The federal government must present evidence that meets the constitutional standard of proving beyond a reasonable doubt that you’ve committed a crime. When we examine and question their evidence, we’ve seen the following results on a regular basis:

• Case dismissal
• No criminal charges
• Clients maintain their professional license
• Civil fine without a criminal plea
• Reducing a felony to a misdemeanor
• No prison time

Lack of criminal intent. In addition to proving that you’ve committed a crime, the government must also show that you acted with criminal intent. However, most instances of Medicare fraud cases in California aren’t caused by people with criminal intent. They are caused by honest mistakes. The most common mistakes include:

• Unqualified or untrained staff
• Inadequate supervision of staff
• Delegation and outsourcing of work to unqualified entities
• Business errors
• Human error
• Oversight
• Employees who are overwhelmed
• Lack of a Medicare compliance program
• Failure to keep up with the quickly changing health care laws and rules

Despite the fact that the above list of causes are not criminal actions (although they may certainly need to be corrected), when most practitioners, facilities, and businesses find out that they’re being accused of Medicare fraud, they just accept whatever consequences that the federal government levies against them. This often means that they’re no longer able to continue to work in the medical field.

Applicable and strategic defenses. All Medicare fraud cases have some similarities. However, each allegation has its own set of facts. Because of this, we take the time to review each case to develop strategic and applicable defenses for our California clients. We recently handled a case where the government alleged that our client fraudulently certified home health care services. We proved to the government that our client was protected by a recognized delegation exception that rendered the certification fully compliant with the law. In another case, we refused to admit liability. We proved to federal prosecutors that our client acted within a safe harbor exception.

The Criminal Defense Firm

The Criminal Defense Firm provides Medicare and health care fraud defense to California health care businesses, lawyers, executives, providers, clinics, hospitals, labs, pharmacies, and other healthcare-related businesses being investigated for illegal kickbacks, fraudulent billing practices, and allegations of medically unnecessary services, services not rendered, and unlawful joint ventures. We can help you with:

• Health care fraud defense
• Compliance program creation and implementation
• Internal investigations
• Asset protection
• Licensure or disciplinary proceedings
• Jury trials

We provide legal advocacy for providers, businesses, and facilities in California. If you’re being investigated by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, or California state law enforcement, call us right away. Our initial consultations are confidential and totally free of charge.

Our Track Record

• Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• Defense of a health care services company against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged False Claims Act and Stark Law violations.
  Result: No civil or criminal liability.

• Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged Health Care Fraud.
  Result: No civil or criminal liability.

• Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• Defense of health care marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
  Result: No civil or criminal liability.

• Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
  Result: No civil or criminal liability.

• Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of health care management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

California Medicare Fraud Defense Attorneys

We are available every day of the year. You can call us directly or complete our contact form or email us directly.