Orange County, California Medicare Fraud Defense Lawyers

Providing Health Care Legal Defense for Orange County, CA

The Criminal Defense Firm is had significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our health care law defense firm is comprised of a diverse group of attorneys, including 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. With years of relevant experience and law degrees from the country’s best institutions, our team is prepared to handle your case. Our firm serves clients in Orange County and throughout California.

Health care providers, facilities, and businesses in Orange County, California face a high chance of being investigated for Medicare fraud. If you’re informed that you’re being investigated, you need the assistance of attorneys in health care fraud defense. The Criminal Defense Firm is now serving clients in the Orange County, California area.

Defining Medicare Fraud

Medicare fraud is a federal offense with civil and criminal penalties. It’s a broad term because it isn’t just about Medicare. It involves any federal health care program including Medicaid, Tricare, and federal worker’s compensation. It is the submission of false claims to any federal government health care program. It involves at least one violation of at least one of the following laws:

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

Medicare fraud results in an illegal payment being made by the federal government to a provider, entity, or business after a false or fictitious claim is filed.

In Orange County, California, there is a higher risk of Medicare fraud investigation than in most other areas in the United States. It is one of nine locations that is closely monitored by the Medicare Fraud Strike Force. This is because there are a large number of beneficiaries for federal health care programs. More claims are filed in the area which is why the federal government watches this area so closely. The Medicare Fraud Strike Force’s job is to monitor, investigate, and prosecute Medicare fraud.

The Medicare Fraud Strike Force Team is a hybrid team of investigators and prosecutors from numerous federal agencies including the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. Other agencies are also included. You could come into contact with one or more representatives from each agency. You could also lose your professional license and your hospital privileges or face disciplinary proceedings.

Billing Errors Often Result in Medicare Fraud Investigations

In Orange County, California, most Medicare fraud investigations occur as a result of billing errors. These billing errors are deemed fraudulent billing practices and reimbursement requests. They can include false charges, unauthorized charges, and excessive charges. Common billing errors include:

• Phantom billing (billing for services that weren’t performed)
• Billing for medically unnecessary services or equipment
• Billing for equipment or services that weren’t ordered
• Certifications for medically unnecessary supplies or services (such as medical devices or hospice care)
• Charge inflation
• Double billing for equipment, services, or treatment
• Up-coding for equipment, services, disorders, or treatment
• Overuse of services
• Overuse of equipment
• Providing or accepting kickbacks

The most commonly investigated individuals and entities in Orange County include doctors, nurses, health care services, nursing homes, registered care facilities, hospitals, clinics, pharmacies, DME providers, labs, DNA centers, and cancer treatment centers.

A Look at Civil and Criminal Penalties

Medicare fraud investigations are extremely serious matters than can result in civil and criminal penalties. Civil penalties may include:

• Assessment of treble damages
• Civil fines of up to $11,000 per false claim
• Recoupment requests
• Non-payment of future claims
• Exclusion from federal health care programs
• Assessment of attorney fees

Criminal penalties may include:

• A criminal record
• Fines that cost you hundreds of thousands of dollars
• 10 years in federal prison for each count of Medicare fraud for which you are convicted
• 20 years for each count of Medicare fraud if it resulted in serious bodily injury to the patient
• A life sentence if the Medicare fraud resulted in the death of the patient

Choosing the Right Defense Lawyer Is Critical

If you’re being investigated for Medicare fraud, it is critical that you choose the right Orange County defense attorney. The attorney should have the skills and experience that you need during the investigation, for negotiation, and even for trial.

Many in Orange County believe that they should choose a health care attorney. When Medicare fraud is alleged, you are likely to be charged with serious federal crimes such as tax evasion, wire fraud, mail fraud, and money laundering. A health care attorney may know health care law, but they may not have the experience and knowledge of federal criminal defense that you may need. They may not have the negotiation skills to take on the federal government or to face federal prosecutors in a court of law.

Others look for an Orange County criminal defense attorney. Yet, most criminal defense attorneys serving Orange County aren’t experienced enough to handle federal criminal charges. They may not have the necessary knowledge of the intricacies of billing, coding, and medical utilization rules that are involved. Medicare fraud is a very serious allegation. You should not rely on someone who doesn’t have the right experience. The risks are just too great.

Look for a health care fraud defense attorney serving Orange County, California. As you research your options, look for these four key areas:

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

Once you’ve found a firm that displays those traits, your research isn’t over. You should ask the following three questions to get a good understanding of just how much experience they have with Medicare fraud cases:

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

The Criminal Defense Firm serves Orange County, California health care providers, entities, and businesses using our three core principles and with strategic defenses. Many of our attorneys have previous experience as federal health care prosecutors with the Department of Justice. This experience has helped us craft our core principles. Our goal is to resolve the investigation while reducing the risk of criminal charges.

Early contact with the government. We’ve learned that one of the very best strategies we can use in a Medicare fraud case is to get involved early with the investigating agencies. If the government has too much uninterrupted time to investigate you, you are more likely to face criminal charges. We get into contact with the investigating agencies and get answers for you usually within hours of our engagement. We’ll find out:

• 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 use evidence to prove that you’ve committed a crime. Their evidence must meet a standard known as “beyond a reasonable doubt.” When we question the validity of their evidence, we’ve routinely seen the following results:

• 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. The government must also prove that you acted with criminal intent. This is hard for the government to prove because most Medicare fraud investigations in Orange County, California are a result of honest mistakes and not because there was an intent to defraud the government. 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

There are very few legitimate cases of Medicare fraud in Orange County, but many businesses and providers who are accused of Medicare fraud because of an honest mistake just assume they must have committed a crime and they accept whatever penalties the government levies against them; this includes criminal penalties. Because of this, many people are no longer able to work in the medical field.

Developing applicable defenses for each case. Although Medicare fraud cases have some similarities, each case is different. We take the time to review each case and develop strategic and applicable defenses. Recently, we recently handled a Medicare fraud 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 aggressive Medicare fraud defense for Orange County, California health care businesses, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other health care entities under investigation 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

The Criminal Defense Firm provides legal advocacy for providers, businesses, and facilities in Orange County, California. If you’re under investigation by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, Orange County 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.

Medicare Fraud Defense Attorneys Serving Orange County, California

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