Los Angeles Healthcare Fraud Defense Lawyers
It shouldn’t be surprising to learn that fraud can often occur in the healthcare industry, one of the most complex areas of business in the United States. Healthcare fraud is a unique crime due to the fact that the most common defendants in these cases are doctors, nurses, and other medical professionals. That being said, anyone who knowingly defrauds or attempts to defraud any federal healthcare benefit program can be convicted of healthcare fraud, including patients.
If you or a loved one has been charged with healthcare fraud, you might find yourself facing long-term penalties and a difficult road ahead. It’s best to work with a team that has a proven track record of helping clients from all walks of life fight their charges and protect their reputation. At Werksman Jackson & Quinn, LLP, our team of Los Angeles white-collar crime attorneys will provide you with the representation you need. Give us a call at (213) 688-0460 to learn more.
There are a number of ways to commit a fraud crime, especially healthcare fraud. However, under California Penal Code 550, healthcare fraud is defined as committing, or helping someone to commit, any of these acts:
- Knowingly presenting a false claim for the payment of a loss or an injury
- Intentionally submitting a claim for a healthcare benefit that was not used 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 an intent to defraud
Under these terms, medical professionals, employees of insurance companies, and patients can all face charges of healthcare fraud in one form or another. Depending on the nature of the fraud, defendants in a healthcare fraud case may face accusations of any number of illegal acts. These include:
- Prescription drug fraud: misrepresenting yourself to a doctor or pharmacist in an effort to obtain controlled substances. More commonly, pharmacists can be accused of healthcare fraud if they knowingly charge an insurance company after they dispense drugs that are expired or incorrect for the prescription.
- Health insurance fraud: intentionally filing false claims in order to be reimbursed by an insurance provider. Medical providers can be charged with health insurance fraud if they billed their patients for an unnecessary service or procedure, or if they filed a claim for a more expensive procedure than what was actually performed. On the patient side, if you sell your insurance information or allow someone else to use your health insurance card to receive healthcare, you could be charged with healthcare fraud.
- Medical fraud: when a physician, nurse, or another medical provider provides medical services without a license or under other false pretenses. Common signs of medical fraud are the use of unproven treatments, providing questionable diagnoses, and other unethical behavior.
In California, healthcare fraud is considered a “wobbler” crime, which means it can be charged as a misdemeanor or a felony. Typically, the prosecutor decides based on the amount of money involved. Any healthcare fraud under $950 will be charged as a misdemeanor, and conviction will result in the following penalties:
- Up to six months in county jail
- A fine of up to $1,000
If the amount is over $950, then the prosecution may still elect to charge the defendant with a misdemeanor. If they do, the penalties could include:
- Up to one year in jail
- A fine of up to $1,000
However, if the prosecution decides to charge the defendant with a felony, then a conviction could result in:
- 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 amount of money involved, depending on which is greater
It is important to remember that a felony conviction doesn’t just lengthen your prison sentence -- it also results in a loss of important rights. In California, felons are not allowed to vote while in jail. They may never own or even use a firearm for the rest of their life. Felons also lose the right to certain valuable community services, such as housing aid. Ultimately, if you cannot beat your charges completely, you should aim for a misdemeanor conviction instead of a felony one. Doing so can be difficult -- which is why you need an excellent defense.
Healthcare fraud, like most other fraud crimes, is an intent crime. This means that conviction hinges on the prosecution proving that you intended to commit fraud. Committing fraud and making a mistake on a form while at the doctor’s office are two very different things, and only one can result in you being sent to jail. Due to intent being required, there are two defenses most often utilized in healthcare fraud cases:
Lack of intent: Healthcare forms can be confusing. It is incredibly easy to write in the wrong information, check the wrong box, or sign the wrong form. While you may have accidentally committed fraud, making a mistake does not mean you should go to jail. Pointing out that your so-called “fraudulent act” was just an honest slip-up could be enough to get your charges dropped.
Lack of knowledge: If you were caught up in a fraud scheme involving other people, then the best defense is a lack of knowledge. Again, the prosecution must be able to prove that you truly intended to commit fraud. If you were under the impression that you were doing your friend a favor, then you cannot be convicted of fraud, unless the prosecution can show that you were aware that your actions were illegal.
However, it can take weeks, even months, of investigation in order to find the perfect ways to undermine the prosecution. Not just any attorney will be able to do this. You need to work with one of the best criminal defense teams in Los Angeles.
Any medical professional who is accused of healthcare fraud will be facing significant risk to their reputation and their ability to practice medicine in the future. Due to the complexity of the laws surrounding healthcare fraud, it is necessary that you consult with a team that has the experience dealing with these cases in both state and federal courts. Working with Werksman Jackson & Quinn, LLP, will give your case the strength it needs by providing an aggressive and determined criminal defense strategy. Our team is ready to help you protect your future and your livelihood. Contact us at (213) 688-0460 to get started.
Recent Case Results
- Complete Dismissal of Molestation Charges
Attorney Mark Werksman’s 29 year old client was falsely accused of molesting two neighborhood children and was subsequently charged with felony child molestation, with a significant prison sentence hanging over his head should he be convicted. Instead, at the preliminary hearing Werksman was able to convince the court to grant his client a complete dismissal of any charges.
- Decision Set Aside
Client, a college student in a faulty Title IX case, was awarded $130,000 in attorney fees.
- Probation with No Jail Time for Drug Money Laundering Charge
Wilmington man accused in New York federal court of laundering drug money through the sale of laptop computers. Mark was able to get the case transferred to federal court in Los Angeles, where he convinced the United States Attorney to reduce the charges. His client was sentenced to probation with no jail time on a misdemeanor conviction.