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What Should I Do If I’ve Been Accused of Healthcare Fraud?

By Los Angeles Criminal Defense Attorney on September 30, 2024

Facing a healthcare fraud accusation can be an intimidating and distressing experience with serious legal consequences that may include substantial fines and imprisonment. Seeking prompt legal counsel is essential to protecting your rights and professional reputation in these challenging circumstances. A Los Angeles criminal defense attorney can assist you in understanding the allegations and developing a strategic approach to your case, potentially negotiating with prosecutors to mitigate the charges.

What Is Healthcare Fraud?

Under California Penal Code 550, healthcare fraud encompasses a range of illegal activities. Some common examples include:

• Knowingly presenting a false claim for the payment of a loss or injury
• Intentionally submitting a claim for a healthcare benefit not utilized by the claimant
• Knowingly submitting a false claim for payment on behalf of any workers’ compensation health benefits
• Presenting multiple claims for the same healthcare benefit with intent to defraud

These actions could involve medical professionals, insurance company employees, and patients. Additionally, healthcare fraud can take the form of prescription drug fraud, where pharmacists are accused, or insurance fraud involving false claims.

What Are the Legal Penalties of Healthcare Fraud?

Healthcare fraud in California is considered a “wobbler” crime, meaning it can be prosecuted as either a misdemeanor or a felony based on the amount involved. Here are the possible penalties:

• Misdemeanor (for fraud under $950):
  • Up to six months in county jail
  • A fine of up to $1,000
• Misdemeanor (for fraud over $950):
  • Up to one year in jail
  • A fine of up to $1,000
• Felony:
  • Between two to five years in county jail
  • A probationary period of up to one year
  • A fine of up to $50,000 or double the involved amount, whichever is greater

Felony convictions also result in the loss of vital rights, such as the ability to vote while incarcerated and the lifelong prohibition from owning firearms. To mitigate these severe consequences, it is advisable to seek a misdemeanor conviction, highlighting the importance of having an adept Los Angeles criminal defense lawyer.

Immediate Actions After Being Accused of Healthcare Fraud

When accused of healthcare fraud, it’s essential to remain silent and consult only with your attorney. You also want to collect and preserve evidence if accused of healthcare fraud.

Stay Silent and Seek Legal Help

Discussing the case with others can jeopardize your defense. Everything you say may be used against you in court. Prioritize hiring a knowledgeable Los Angeles criminal defense lawyer who is knowledgeable in healthcare fraud. They will help you understand the allegations, guide you legally, and craft a strategic defense.

Swift action in securing legal counsel protects your rights and strengthens your chances for a favorable outcome. Early legal intervention is critical in addressing healthcare fraud complexities.

Preserve and Gather Evidence

Organize documents like billing records, patient files, and insurance communications. This information is essential for your defense and can help your attorney challenge the prosecution. Document relevant interactions and maintain thorough records of business practices to demonstrate transparency. Do not alter or dispose of any documents, as this may be seen as concealing evidence.

Working with a skilled Los Angeles healthcare fraud defense lawyer ensures you gather and use the right materials effectively. Additionally, taking these steps prepares you to navigate legal complexities and safeguard your professional standing.

Legal Process for Healthcare Fraud Cases

Each healthcare fraud case is unique, and the specific circumstances will determine whether you will have to go to trial, which defense strategies are most applicable, and whether plea bargaining is optimal or not.

Will I Have to Go to Trial?

Going to trial depends on several factors, including the evidence against you and the defense strategy your attorney develops. Many cases are resolved before reaching trial through plea negotiations or by demonstrating insufficient evidence to support the charges. A skilled criminal defense lawyer can negotiate with prosecutors to seek a favorable plea deal, potentially reducing the severity of charges or penalties. However, if the prosecution is unwilling to negotiate or if the defense believes a trial would yield a better outcome, the case may proceed to trial. During this process, your attorney will present evidence, cross-examine witnesses, and argue on your behalf to establish reasonable doubt.

While the prospect of a trial can be daunting, having experienced legal representation significantly enhances your chances of securing a favorable verdict or minimizing potential penalties.

Possible Defenses

When facing healthcare fraud charges, there are several possible defenses that a skilled lawyer might employ, including:

• Lack of Intent: Demonstrating that there was no intention to defraud is a common defense. Mistakes or clerical errors in billing do not constitute fraud if there was no intent to deceive.
• Lack of Knowledge: Arguing that the accused was unaware of the fraudulent actions can be a valid defense, especially if the individual did not directly handle billing or claims processing.
• Insufficient Evidence: Challenging the sufficiency of the evidence presented by the prosecution can lead to charges being dropped if the evidence does not meet the legal standard of proof.
• Mistaken Identity: In some cases, the defense might argue that the wrong person was accused of committing fraud, particularly in complex organizational structures.

A criminal defense attorney will assess your situation to tailor a defense that best addresses the accusations.

Plea Bargaining

Plea bargaining is key in healthcare fraud legal proceedings. It involves an agreement with the prosecution to plead guilty to lesser charges, often reducing penalties. This benefits both sides: the defendant avoids trial uncertainty, and the prosecution secures a conviction efficiently.

A lawyer is crucial in these negotiations, as they use their knowledge to aim for the best outcome. They also evaluate the case to decide if plea bargaining is optimal. However, accepting a plea deal means admitting some guilt, so it must be considered carefully.

Call Werksman Jackson & Quinn LLP For Legal Help

When facing the complexities of healthcare fraud charges, reaching out to the attorneys at Werksman Jackson & Quinn LLP can be a decisive step in securing your defense. Our goal is to protect your rights, mitigate the charges, and achieve the best possible outcome.

Our lawyers are renowned for our credibility—that’s why our firm has been featured in major media outlets like the Los Angeles Times and CBS News. We provide personalized guidance, from the initial stages of an investigation through to any potential trial proceedings, to ensure your case is handled with the utmost professionalism.

Do not hesitate to call Werksman Jackson & Quinn LLP at (213) 688-0460 for a consultation with one of our experienced white-collar crime defense attorneys in Los Angeles; early intervention can significantly influence the course of your legal journey and your future.