Los Angeles Healthcare Fraud Defense Attorneys
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 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.
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.
Depending on the specific details of the case, such as the severity of the fraud and the criminal background of the accused, a healthcare fraud conviction carries different possible penalties. In the state of California, healthcare fraud is known as a “wobbler” crime, which means that prosecutors have the freedom to treat it as either a misdemeanor or a felony. As a misdemeanor charge, the penalties likely amount to paying restitution for the money that was fraudulently obtained, and up to one year in jail.
In addition to California Penal Code 550, there are several federal laws pertaining to healthcare fraud. The False Claims Act, the Anti-Kickback Statute, and other regulations are important rules in place to address healthcare fraud that occurs at the federal level. When a healthcare fraud case is tried in federal court, those convicted could serve up to 20 years in prison.
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.