blog home White-Collar Crime The Ins and Outs of California Healthcare Fraud

The Ins and Outs of California Healthcare Fraud

By Los Angeles Criminal Defense Attorney on January 11, 2019

Since the beginning of Medicare, healthcare fraud has been a serious issue affecting the entire healthcare industry. This criminal activity can take many forms, and may hinder doctors and hospitals in providing affordable treatments to patients, especially those who are economically disadvantaged. Law enforcement takes allegations of healthcare fraud very seriously.

Unfortunately, the current state of California’s healthcare laws, especially in regards to the Affordable Care Act, has made it difficult for healthcare providers to navigate the onerous rules and regulations. A healthcare provider may be violating rules that he doesn’t even know exist, yet the mere suspicion of fraud can ruin the good name of an innocent healthcare provider!

To learn how Werksman Jackson & Quinn LLP can help you fight against federal healthcare fraud charges, call (213) 688-0460 today.

What Is Healthcare Fraud?

Healthcare fraud is a form of white-collar crime that involves filing fraudulent medical claims in order to receive illegal compensation.

  • Health insurance fraud would involve a person or company filing false claims to be reimbursed by an insurance provider. One of the biggest targets with these schemes is Medicare.
  • Drug fraud typically involves getting unnecessary or false prescriptions and then selling that medication for profit.
  • Medical fraud normally entails a doctor or other medical professional who is practicing medicine under false pretenses, for instance, without a medical license.

Healthcare fraud can take many other forms. One major example revolves around billing for procedures that were never actually performed. Healthcare fraud often targets Medicare, and might be done through forgery of medical forms, or through the use of kickbacks or bribes to medical professionals. Upcoding is when a more expensive procedure or item is billed than the one actually performed or provided. A doctor may submit duplicate claims adjusted just enough to make them look like separate occurrences, but the procedure was performed once. Unbundling is when services are charged separately, even though they were provided at the same time, because charging individually for each service costs more than all at once. Performing unnecessary or excessive services might involve a long list of tests and exams, or additional care that is more than what the diagnosis calls for. In such cases, the patient may not know he is being subjected to unnecessary testing or procedures.

Because forgery is involved in most healthcare schemes, a doctor’s signature should not be proof he or she had any knowledge of or participation in illegal activity.

What Happens If You’ve Been Charged with Healthcare Fraud?

If you are a medical professional under suspicion of fraud, your entire career could be in jeopardy. A conviction carries severe penalties, including jail time, fines, and the loss of your medical license. You can’t wait to take action—if you can, defend yourself before formal charges are brought.

Healthcare fraud is primarily investigated by the FBI, as they have jurisdiction over both federal and private insurance programs. Federal charges are difficult to defend against and can be expensive to fight, especially if your case goes to trial. Your best bet is to get your charges dismissed or reduced, and the sooner you start building a solid defense, the better.

Los Angeles is one of nine regions under the surveillance of the Medicare Fraud Strike Force. This investigative team is made up of a variety of agencies, including the Department of Justice, the Department of Health and Human Services, the Office of Inspector General, and the FBI. In 2016, the Department of Justice investigated over 300 cases of healthcare fraud. Of those, 80 concerned individual healthcare providers, while the others centered on healthcare entities and businesses. In total, the agency recovered more than $900 million in fraudulent claims, which gives them plenty of incentive to keep looking.

Defending yourself against charges of healthcare fraud in Los Angeles is challenging. You need a defense team that specializes in federal prosecution and has a proven track record of success. At Werksman Jackson & Quinn LLP, our knowledgeable white-collar crime lawyers are ready to help you protect your good name. Call (213) 688-0460 or contact us today to schedule a free and confidential consultation.

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