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Understanding Medicare Fraud Charges Against California Dentists

The federal government’s Medicare Fraud Strike Force is targeting dental practices in California for both civil and criminal prosecutions. If you are under investigation or have been charged with Medicare fraud in California, learn what you need to do to protect your practice.

With Medicare fraud continuing to cost the federal government and taxpayers hundreds of billions of dollars every year, healthcare providers are increasingly finding themselves at the center of federal investigations. These investigations are often led by the Medicare Fraud Strike Force, a coordinated law enforcement effort with teams around the nation.

Recently, the Medicare Fraud Strike Force has enhanced its efforts to target California healthcare providers, including dentists throughout the state. Earlier this year, federal prosecutors in California charged 22 providers for their alleged roles in a scheme to defraud the Medicare system of $162 million as part of a national takedown involving as much as $900 million in fraudulent billings. The Medicare Fraud Strike Force is continuing to investigate new cases as prosecutors take care of pursuing civil and criminal charges; and, if you are a dentist or own dental practice in California, it may only be a matter of time before your practice comes under investigation, if it hasn’t already.

Protecting Yourself in a Medicare Fraud Investigation

Facing allegations of Medicare fraud is an extremely serious matter. If your investigation leads to civil charges, you could face fines of up to $11,000 per false claim, treble damages, and other financial penalties. You could lose your ability to participate in Medicare and other federal government benefit programs. Your practice could be shut down.

If it leads to criminal charges, the potential consequences get even more severe. In a criminal Medicare fraud case you could face years, and possibly even decades, behind bars.

If your dental practice is being investigated for Medicare fraud, defending yourself in the government’s investigation needs to be your top priority. You want to end the investigation before it leads to civil or criminal charges. This will require the help of an experienced legal team focused on healthcare fraud defense, and you will need to work closely with your attorneys so that they can get ahead of the investigation and mount the strongest possible defense.

Common Allegations in Medicare Fraud Investigations

So, what exactly is Medicare fraud, and what types of activities can draw the attention of the Medicare Fraud Strike Force?

Medicare fraud actually is not one specific federal offense, but rather a category of federal offenses that involve obtaining reimbursements under the Medicare system through improper means. The most common forms of Medicare fraud include: (i) submitting false information to the federal government (including the Centers for Medicare and Medicaid Services (CMS)), and (ii) billing Medicare for reimbursement of services, supplies, and equipment that are not reimbursable under the law.

For example, the Medicare Fraud Strike Force, CMS, and other federal agencies regularly investigate dentists and other healthcare providers suspected of:

  • Billing for services that were not actually performed
  • Billing for supplies and equipment that were not actually purchased
  • Billing for services, supplies, and equipment that were not medically necessary
  • Double-billing for services, supplies, and equipment
  • Falsifying patient records
  • Unbundling services in order to bill at higher reimbursement rates
  • Up-coding services to higher reimbursement rates
  • Offering and accepting kickbacks from physicians, durable medical equipment (DME) companies, pharmaceutical companies, and others

The Medicare Fraud Strike Force is increasingly relying upon data analysis to identify potential targets for fraud investigations. As stated on the Medicare Fraud Strike Force’s website, “[Our] teams have a proven record of success in analyzing data and investigative intelligence to quickly identify fraud and bring prosecutions.” Unfortunately, in many cases, this focus on data results in innocent dentists facing invasive investigations that prove to be unjustified once the true facts are revealed.

Possible Defenses to Medicare Fraud Allegations

For example, under 18 U.S.C. Section 1347, one of the primary statutes that the federal government uses to prosecute those suspected of Medicare fraud, prosecutors must prove that the target, “knowingly and willfully execut[ed], or attempt[ed] to execute” a fraudulent scheme. Under this statute, if you did not “knowingly” or “willfully” submit a false or fraudulent claim, you are not guilty of Medicare fraud. Billing data cannot demonstrate a dentist’s or other healthcare provider’s intent. As a result, our team is often able to resolve client’s investigations by challenging the government’s evidence of intent.

The Medicare billing system is immensely complicated, and the government is constantly changing the rules of the game. For dentists and providers to stay on top of the latest Medicare billing regulations is practically a full-time job in itself. While this does not mean that providers have a free pass to ignore the rules, it does mean that they have a legitimate defense to Medicare fraud charges if they did not knowingly or willfully violate the law.

What to Expect Once the Government Commences an Investigation

Nonetheless, innocence does not guarantee safety from a federal investigation. If federal agents suspect that your dental practice may be engaging in Medicare fraud, it is their duty to conduct an exhaustive investigation. Here is what you can expect if agents from the Medicare Fraud Strike Force, CMS, the Federal Bureau of Investigation (FBI), Office of Inspector General (OIG), or another federal agency show up at your dental practice’s door:

1. Expect Lots of Questions

Federal Medicare fraud investigators ask lots of questions. Lots of questions. They are trained not only ineffective investigative and interrogation techniques but also in the details of the Medicare system. They know how to solicit the information they are looking for, and their sole focus is determining whether there is enough evidence to justify a civil or criminal prosecution.

2. Expect to Be Asked for Records

While you are being questioned, federal investigators may ask for copies of your dental practice’s records. You may also receive a subpoena demanding that you release certain records to the government. Once again, the purpose of the government’s request for this information is to uncover evidence that it can use against you.

3. Expect Agents to Want to Talk to Your Employees

Federal investigators may also want to talk to your employees, including your Chief Financial Officer (CFO) and any staff members who are involved in preparing patient records, patient billing, or submitting reimbursement requests to Medicare. You should not let them unless advised to do so by your attorney.

4. Expect to Face Charges if You Don’t Hire a Lawyer

Once the government has collected enough evidence from these sources to suggest that you may be involved in Medicare fraud, you can expect to face federal charges. The Medicare Fraud Strike Force is both exhaustive and efficient in its investigative efforts; and, before you know it, what seemed like a few harmless questions can quickly lead to an indictment and prosecution.

This is why you need to hire a medicare fraud defense lawyer as soon as you find out that you are under investigation. You do not have to give federal investigators everything they ask for, and an experienced healthcare fraud defense attorney will be able to intervene in the investigation and advise you on what you can (and can’t) do to protect your rights.

Choosing a Medicare Fraud Defense Law Firm

The The Criminal Defense Firm is a team of experienced healthcare fraud defense attorneys who have experience defending dentists and other healthcare providers in Medicare fraud investigations nationwide. Our firm’s founder is a nationally recognized leader in healthcare fraud defense, and the other senior attorneys in our Healthcare Fraud Defense Group are all former prosecutors who bring decades of combined experience to the table. We know Medicare fraud cases inside and out, and we rely on proven defense strategies to help our clients avoid civilly and criminal charges and otherwise minimize the consequences of their federal investigations.

When you are facing a federal investigation, experience matters. Presenting the strongest possible defense requires:

  • Experience in Healthcare Fraud Defense At The Criminal Defense Firm, we have successfully defended clients in Medicare and other healthcare fraud investigations in California and across the country. To date, not one of our clients has been forced to shut down operations due to an investigation we have defended.
  • Experience Inside the Government We nationally recognized Healthcare Fraud Defense Group includes a former federal prosecutor, who handled complex investigations and prosecutions for the government prior to joining The Criminal Defense Firm

At The Criminal Defense Firm we take a unique team approach to defending our clients in Medicare fraud investigations. This approach affords each client the full benefit of our Healthcare Fraud Defense Group’s decades of combined legal experience.

Schedule a Free Consultation with Defense Team at The Criminal Defense Firm

If your dental practice is under investigation for Medicare fraud, you do not have time to waste. To schedule a free, confidential case assessment with the attorneys in our Healthcare Fraud Defense Group, call (714) 602-4316 or contact us online today.

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.
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