What to Do if You’re an Arthritis Doctor Charged with Medicare Fraud in California?
The federal government’s Medicare Fraud Strike Force is a team of federal agents and prosecutors who are committed to prosecuting arthritis doctors and other healthcare providers who submit false and fraudulent claims for Medicare reimbursement. Increasingly, the Medicare Fraud Strike Force is targeting specialized practitioners in California. Regardless of whether you believe that you may have committed Medicare fraud, you need to take your situation extremely seriously. This starts with putting a team of experienced healthcare fraud defense attorneys on your side.
Since uncovering a $900 million Medicare fraud scheme that led to charges against 22 physicians and other healthcare providers in California federal court, the federal government’s Medicare Fraud Strike Force has taken an increased interest in the practices of arthritis doctors and other specialized practitioners in the Golden State. With the Medicare Fraud Strike Force’s highly publicized data-driven approach, this is in many cases leading to investigations targeting medical practices that either (i) have not done anything wrong at all, or (ii) if they have done something wrong, it was an honest human error that does not justify federal charges for Medicare fraud.
At the The Criminal Defense Firm, we are closely monitoring the situation in California, and we are actively representing doctors, medical practices, and other healthcare industry players in Medicare fraud investigations across the country. If your California arthritis practice is under investigation by the Medicare Fraud Strike Force, the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), the Office of Inspector General (OIG) or any other federal agency, we urge you to contact us immediately for a free, confidential case assessment.
Do I Need Legal Representation During the Government’s Investigation?
Yes, hiring legal representation for your Medicare fraud investigation is critical. The federal agents and prosecutors who handle Medicare fraud cases are highly experienced at building cases against investigation targets in order to pursue civil, and in many cases criminal, charges. By hiring a defense team during your investigation, you can:
- Avoid unwittingly providing damaging statements or disclosing potentially incriminating records that you are under no legal obligation to provide or disclose.
- Have your defense attorneys intervene in the investigation and communicate with investigators and prosecutors on your behalf.
- Determine whether the investigation is civil or criminal in nature, and implement a strategic defense plan designed to avoid having your investigation lead to federal charges.
Why is My Practice Under Investigation for Medicare Fraud?
There are any number of reasons why your practice may be under investigation for Medicare fraud. If your investigation is the result of the Medicare Fraud Strike Force’s use of data analytics, it could be because your practice has a record of submitting reimbursement claims that are “out of the norm.” This does not mean that they are fraudulent, it just means that they do not fit with the rest of the government’s data for other similar types of practices. Submitting a large number of reimbursement claims, commonly submitting certain types of reimbursement claims, and other practices that may be completely normal for you as an arthritis doctor may look abnormal when viewed through the lens of data analytics and this is enough to spark an investigation.
Of course, it could also mean that you have submitted improper reimbursement claims. Here, too, improper does not necessarily mean fraudulent you must have intent in order to commit fraud but making mistakes with regard to your Medicare reimbursement claims is a surefire way to grab the government’s attention. Common issues that can lead to Medicare fraud investigations include:
- Billing for medically unnecessary services, supplies, or equipment
- Billing for services that were never performed or equipment and supplies that were never ordered
- Double-billing
- Providing certifications for medically unnecessary supplies or services
- Providing or accepting kickbacks
- Upcoding, unbundling, and inflating charges
Have I Actually Committed Medicare Fraud?
Maybe, but most likely not. In the vast majority of cases, what the government alleges to be fraud turns out to be honest human error. The fact that you are under investigation does not mean that you are guilty, and it is critical that you keep this in mind throughout the course of the investigation. When we assess your case, we will determine whether you have any statutory defenses available (such as a safe harbor exception), and we will determine the best way to refute the government’s evidence in order to protect you from facing federal charges.
What if I Am Found Guilty of Medicare Fraud?
First, it is important to understand that Medicare fraud can be charged as either a civil or criminal offense (but, again, our goal is to make sure that you are never charged). If you are found liable in a civil case, you can face penalties that include recoupment requests, treble (triple) damages, fines of $11,000 per false claim, and other forms of financial liability. If you are found guilty in a criminal case, you can potentially face decades of incarceration in a federal penitentiary.
What Steps Can I Take Now to Protect My Practice?
If you are an arthritis doctor facing a Medicare fraud investigation in California, there are several steps that you need to begin taking as soon as possible. To protect your practice, you should:
- Avoid speaking to investigators or allowing your employees to speak to investigators without legal representation.
- Avoid speaking with anyone about the investigation other than your fraud defense attorneys. Anyone with information relevant to the government’s allegations could become a witness against you.
- Note any deadlines on subpoenas and any other written requests you receive, but do not respond until you speak with an attorney.
- Make sure that your employees do not dispose of any files or erase any electronic records.
- Choose an experienced healthcare fraud defense law firm that can take control of the investigation and challenge the government’s evidence (if any) against you.
What You Should Do When You Are Under Investigation
for Health Care Fraud
At The Criminal Defense Firm, we offer all new clients who are facing Medicare fraud investigations our Emergency Defense Package. Featured by media outlets around the country, our Emergency Defense Package includes key resources for protecting yourself, your employees, and your practice:
- General Protocols: What to Do
- Instructions for Management: How to Deal with Agents
- Instructions for Management: How to Deal with Employees
- Instructions for Employees
- Document Retention Forms
- Compliance Examination Instructions
- Important Contact Information
How Do I Choose the Right Law Firm for My Medicare Fraud Investigation?
Your choice of legal representation can have a drastic impact on the outcome of your Medicare fraud investigation. So, how do you choose the law firm that will give you the best chance to avoid facing civil and criminal charges?
First, you need to choose the right type of law firm. There are criminal defense law firms. Then, there are law firms that practice healthcare law. Then, there are a select number of firms that focus their practice in the area of healthcare fraud defense.
At The Criminal Defense Firm, our Healthcare Fraud Defense Group is comprised of nationally recognized healthcare fraud defense lawyers who have handled hundreds of fraud cases in California and nationwide. Our Health Care Fraud Defense Group includes experienced former federal prosecutors, many of whom spent time on the Medicare Fraud Task Force. With decades of combined experience, our attorneys use proven strategies to defend California arthritis doctors and other practitioners in complex Medicare fraud investigations.
You need to choose your legal representation quickly, but you also need to make an informed decision. During your free case evaluation, in which you will meet with the senior attorneys from our Health Care Fraud Defense Group, we encourage you ask us questions such as:
- How many Medicare fraud investigations have you handled as defense attorneys? As federal prosecutors?
- Does healthcare fraud defense make up a significant portion of your practice?
- How familiar are you with the Medicare fraud billing system and its most-recent changes?
- What are “safe harbors” and how might they apply to my case?
- Will you assign senior attorneys to handle my case?
- Do you have a track record of success in Medicare fraud investigations?
- How quickly can you intervene in the government’s investigation?
- What role will I play in your defense strategy?
- What mistakes do I need to avoid in order to help preserve my defenses?
- What are the potential outcomes in my case? How likely am I to face civil or criminal charges?
What Do I Need to Do to Get Started?
To learn more about the attorneys in our Healthcare Fraud Defense Group and find out what defenses you have available, the first step is to schedule a free case evaluation. You can do so by calling us at (714) 602-4316 or submitting our defense evaluation form. Our attorneys will make arrangements to meet with you as soon as possible. If you choose to work with us, we will take swift and aggressive action to intervene in the government’s investigation.
Brian Kuester offers his extensive experience to counsel companies and individuals under civil or criminal government investigation. When resolution requires litigation, clients choose Mr. Kuester’s proven court and litigation experience.