False Claims Act Violations in the State of California

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Health Care Legal Defense Team Serving California

Brian Kuester
Attorney Brian Kuester
California False Claims Act Team Lead
Former US Attorney
Former District Attorney
Ellen Comley
Attorney Ellen Comley
Defense Team Lead
Senior Counsel
Roger Bach
Roger Bach
Team Consultant
Former Special Agent (OIG)
The Criminal Defense Firm is a health care law defense firm that works cases that deal with regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our team of lawyers includes the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, former lead prosecutors of the elite Medicare Fraud Strike Force, and other talented attorneys with years of relevant experience and who studied at the nation’s best law programs. Our firm serves clients throughout the state of California and its surrounding areas. In California, violating the False Claims Act is an extremely serious federal matter. Investigations can include health care providers, facilities, organizations, or businesses. The Criminal Defense Firm provides strategic defenses for California health care clients who are facing these violations.

The State of California Is Closely Monitored by the Medicare Fraud Strike Force

When it comes to federal health care programs and fraud, the federal government watches the entire nation. However, the State of California is one of nine areas that is closely monitored by the Medicare Fraud Strike Force. This is because the state has a large number of beneficiaries for federal health care programs. Because of this, more claims are filed in California than in other places. The increase in claims leads the federal government to believe that there is a greater likelihood of fraudulent activity. In 2016, the Department of Justice investigated more than 300 allegations and recovered over $900 million in fraudulent claims. The Medicare Fraud Strike Force is a team of investigators and prosecutors from different federal agencies. When you’re investigated, you may come into contact with the Department of Health and Human Services, the Department of Justice, the DEA, the Department of Defense, the FBI, and even the IRS. Often, other federal agencies are also involved. If you or your business is contacted by this team, contact The Criminal Defense Firm without delay.

What You Need to Know About the False Claims Act

The False Claims Act is a federal law that affects any person or business with direct or indirect contracts with and who will be paid by the federal government for federal health care claims. This act creates criminal and civil liability if you knowingly submit or cause the submission of a false claim that is approved and paid by the federal government. It applies to individuals, contractors, businesses, facilities, and organizations in California. Although the law is quite specific, you need to understand the legal meaning of the word “knowingly.” It isn’t just about actual knowledge. It means that if you didn’t know, you should have. In short, it makes it your ultimate responsibility to know that your claims are within the law. Take medical coding as an example. If the wrong codes are used, it is ultimately your responsibility even if you didn’t do the coding. It was your responsibility to ensure that the coder used the appropriate codes.

Civil and Criminal Liabilities Created by the False Claims Act

Regardless of what type of health care provider, facility, or business you are or have in California, violating the False Claims Act can bring civil and criminal liabilities into your life. These penalties are extremely serious and could affect you forever. If you learn that you’re being charged with violating this federal act, contact The Criminal Defense Firm now. Once retained, we can assist you and help you find out which charges you may be facing. Civil penalties may include one or more of the following:
  • Treble damages paying the government three times the amount of the original claim
  • Payment of civil fines of up to $11,000 per false claim
  • Recoupment requests
  • Non-payment of future submitted claims
  • Future exclusion from federal health care programs
  • State licensure or disciplinary proceedings
  • Loss of hospital privileges
Criminal penalties may include one or more of the following:
  • Claims that cost you hundreds of thousands of dollars
  • Criminal charges
  • Up to five years in federal prison

California Qui Tam Lawsuits Often Result in False Claims Act Investigations

Most False Claims Act investigations that occur in California begin because someone filed a qui tam lawsuit. These lawsuits are filed in federal court. Which federal court the case is filed in will depend upon where your practice or business is located and does business. “Qui tam” is Latin that means9 he who sues for the king and himself.) These lawsuits have monetary incentives because the initial goal was to encourage private citizens to help protect the government against acts of fraud. However, what started as a noble intention is now abused in California. These lawsuits are primarily filed by angry former employees and unscrupulous competitors who are just out to punish or hurt you. When a qui tam lawsuit is filed, the state’s federal court seals it. The assigned judge and the federal agencies that are involved are the only individuals who will receive an unsealed copy. The purpose of sealing the document is to protect the identity of the plaintiff. The plaintiff is listed only as the “qui tam realtor.” In California, False Claims Act investigations can be time-consuming. Extensions can be filed and are often granted by the court so that the federal government has all of the time it needs to complete the investigation. During the investigation, you’ll receive subpoenas for various records including your financial, billing, and communication records. These subpoenas can come from the DOJ, DEA, DOD, IRS, FBI, OIG, or any number of federal agencies. The government will review your records and determine whether they will support or decline the lawsuit. If the government declines to get involved, the lawsuit isn’t over. The plaintiff can pursue the lawsuit. If they win, they will be rewarded with 30 percent of the recovered funds. If the government elects to support the qui tam lawsuit, you will likely face additional charges. If the qui tam suit is successful against you, the plaintiff who initiated it will receive 25 percent of the recovered funds as a reward. If you’re named as a qui tam defendant, contact The Criminal Defense Firm right away. We can help you by establishing a strategic defense or an agreeable settlement with the federal government where appropriate.

Principal Strategies for California Clients

The Criminal Defense Firm has principal strategies for California clients. These three strategies were developed by putting our experience as former prosecutors of health care fraud and defense attorneys to use.
  1. The first principle is that The Criminal Defense Firm will work to reduce the risk of criminal charges against our California clients. We will immediately contact the investigating federal agencies. Our goal is to find out the purpose of the investigation, the potential charges, and what can be done to resolve the investigation. We can usually get these answers within days of our engagement. We’ve learned through our experience that early involvement is one of the best ways to resolve these investigations favorably for our clients.
  2. California qui tam lawsuits are a major problem that starts these investigations. In this instance, we work to discredit the allegations and evidence presented against our clients. Our goal is to show that the lawsuit doesn’t deserve the support of the federal government.
  3. In certain cases, our clients face civil liability. In these instances, we negotiate the original damage request from the federal government down to a small fraction. None of our clients have been forced to close down their practice, facility, or business.

The Criminal Defense Firm

The Criminal Defense Firm serves California health care clients. We’ve represented ARNPs, doctors, nurses, hospitals, clinics, practice owners, physician-owned businesses, hospice centers, labs, pharmacies, and other health care businesses accused of False Claims Act violations or named qui tam defendants. We also assist those being investigated for violating Stark Law and the Anti-Kickback Statute or involved in Medicare, Medicaid, Tricare, or Department of Labor investigations.

Our Track Record

  • False Claims Act Investigation (Pharmacy) Result: No Liability.
  • False Claims Act Investigation (Pharmacy) Result: No Liability.
  • False Claims Act Investigation (Laboratory Group) Result: No Liability.
  • False Claims Act Investigation (Laboratory Group) Result: No Liability.
  • False Claims Act Investigation (Laboratory Group) Result: No Liability.
  • False Claims Act Investigation (Physician) Result: No Liability.
  • False Claims Act Investigation (Physician) Result: No Liability.
  • False Claims Act Investigation (DME Company) Result: No Liability.
  • False Claims Act Investigation (MSO) Result: No Liability.
  • False Claims Act Investigation (MSO) Result: No Liability.
  • False Claims Act Investigation (Physician Syndication) Result: No Liability.
  • False Claims Act Investigation (Physician Syndication) Result: No Liability.
  • False Claims Act Investigation (Physician Syndication) Result: No Liability.
  • False Claims Act Investigation (Device Company) Result: No Liability.
  • False Claims Act Investigation (Health Care Service Provider) Result: No Liability.
If you’re in California and if you are being investigated by the federal government for violating the False Claims Act, you should call The Criminal Defense Firm right now. Initial consultations are free and totally confidential.

False Claims Act Defense Attorneys Serving the State of California

We are available to discuss your case. You can call us directly, use our contact form, or send us an email.
714-294-2000 The Criminal Defense Firm Serving the State of California and Surrounding Areas CriminalDefense.com
Not all attorneys of The Criminal Defense Firm are licensed in California and nothing contained in here is meant to constitute the unauthorized practice of law.
Dallas 214-817-2053
Houston 713-454-7814
Detroit 313-634-0925
Baton Rouge 225-269-8749
New York 332-239-7345
Winter Park 407-890-0460
Miami 786-751-3247
Portland 207-222-7742
Nationwide 866-603-4540