Are you a CA Health Care Provider, Medicare Recipient or Medical Supplier Facing Medicare Fraud Criminal Charges?

Tully & Weiss Criminal Lawyers Defend Medicare Fraud Charges throughout California

As the government and law enforcement continue to crack down on Medicare fraud after passing the 2009 Affordable Care Act, the chances of a healthcare provider or Medicare recipient being accused of this criminal activity have increased dramatically. New prosecutions are announced almost daily.

The complicated and tangled system of billing and payment processing allows for plenty of honest mistakes and unscrupulous activity to occur side by side, providing more than ample opportunity for prosecutors to mistakenly charge innocent people of fraudulent acts.

Since Medicare is a federal government-funded program, prosecutors come out seemingly heroic in their recovery of “hard earned taxpayer dollars.” Everyone wants someone to blame and once the finger is pointed at you, it can be almost impossible to recover.

Allegations alone can result in federal indictments, Medicare expulsion and licensing sanctions. If convicted, physicians, physical therapists, nurse practitioners, medical secretaries, pharmacists, counselors, and medical equipment company owners face losing their careers and freedom.

Typical Conduct Characterized as Healthcare Fraud by California Healthcare Providers

California Penal Code 550 governs insurance claims and health care fraud. Submitting a false, altered or forged claim to achieve financial gain from a government-funded health care program is illegal. Fraudulent activity includes:

• Submitting claims for services not rendered
• Submitting claims for medically unnecessary services
• Billing for a more expensive service than received (upcoding)
• Billing for separate services that should have been combined (unbundling)
• Billing generics at brand-name prices
• False Cost reporting
• ID theft
• Medicare supply reselling
• Taking referral fees, gifts or other kickbacks
• Double billing
• Preparing a false document in support of a fraudulent claim
• Aiding, abetting, soliciting, or conspiring in health care fraud

Even if you were not directly involved in a scheme to defraud Medicare, if you were involved in any part of the billing or payment processing, including document preparation or data entry, you could be held criminally liable for the crime.

Medicare recipients/patients are equally vulnerable to being charged with Medicare fraud, for example, by loaning ID numbers to other individuals and/or falsifying application information.

Once you've been charged with health care fraud, the government has set their sights on one goal – sending you to jail and collecting financial compensation. Prosecution is anticipating an easy win. But the health care fraud defense attorneys at Tully & Weiss know the system and aren't intimidated by tough players.

Our defense team does not tolerate sloppy or corrupt law enforcement, dishonest testimony or inadmissible evidence and will ensure your Constitutional rights are upheld throughout the entire process. Don't become a casualty of overzealous prosecution.

What Are The Penalties For A Conviction Of Medicare or other Healthcare Fraud?

Accusation of fraudulent billing for healthcare services or equipment is one of the most destructive charges a health care provider may ever encounter. If the potential dollar amount of fraud is significant, you may find yourself fighting some of the most experienced and confident prosecutors in America.

Medicare fraud cases often involve the Office of Inspector General for the U.S. Department of Health and Human Services and the Federal Bureau of Investigation or other U.S Department of Justice Enforcement group.

The line is drawn at $950 when determining the potential criminal penalties for health care fraud in the state of California. Fraudulent claim amounts are added up for a 12-month period to determine whether the claims exceed or fall short of $950.

Claims totaling equal to or less than $950:

If the total of all fraudulent claims over a 12-month period is $950 or less, the charge is a misdemeanor punishable by a fine of up to $1,000 and/or up to 6 months in county jail.

Claims totaling over $950:

If the total of all fraudulent claims over a 12-month period is greater than $950, the crime is a “wobbler,” meaning it may be charged as a misdemeanor or felony.

Misdemeanors involving more than $950 are punishable by up to 1 year in county jail and/or a fine of up to $10,000.

Felony health care fraud is punishable by up to 5 years in county jail per offense and/or a fine of up to $50,000 or twice the defrauded amount (whichever is larger).

The Department of Justice recovered over $20 billion in fraudulent claims between 2009 and 2014 and doesn't show any sign of slowing. A conviction results in a criminal record, prison time, extensive fines, restitution of the amount defrauded, expulsion from the Medicare program, loss of professional licenses, and possible deportation for non-citizens.

Immediate intervention of experienced legal counsel is your one opportunity to avoid a criminal record and harsh penalties. The attorneys at Tully & Weiss Law Firm know the ins and outs of billing compliance, data analysis, medical necessity and DEA and HHS administrative action.

Medicare fraud attorney Joseph Tully, author of California: State of Collusion, and his hard-hitting defense team of lawyers, staff, and investigators will dedicate every energy to preserving your freedom and professional career.

What Defense Strategies will Your Lawyers Use to Fight Health Care Fraud?

As with most white-collar crimes in the state of California, innocent people are often wrongly accused of health care fraud. However, a number of strategic defense plans developed by our Medicare fraud defense team can help you succeed in your defense and lessen or eliminate the charges against you.

In order to be convicted of criminal Medicare fraud, the prosecutor must be able to demonstrate that each element of the crime was present beyond a reasonable doubt. An experienced California health care fraud defense attorney will build several powerful defense strategies to argue your case and help reduce or dismiss the charges. Two examples of common defenses to a charge of Medicare fraud include:

• Lack of Knowledge: If you can demonstrate that you did not know the claim you prepared and/or submitted was fraudulent, false or duplicated, you cannot be convicted of health care fraud. An argument that you made a mistake or did not understand specific details of the billing process can prove effective in these cases.
• Lack of Intent: In order to be convicted of health care fraud, the prosecution must show that you acted with the intention of defrauding the health care insurance program. If you were simply doing your job and did not intend to receive financial gain from your actions through defrauding the health insurance program, you cannot be held criminally liable.

If you are accused of Medicare fraud, you will be subject to interrogation by government officials. Our California Medicare fraud defense lawyers protect patients, physicians, nurses, pharmacists, and medical equipment vendors from unjust, complicated or incriminating questioning and work to get charges reduced or dismissed altogether.

We are able to suppress (keep out of court) alleged evidence when our clients are subjected to illegal search and seizure in violation of their Constitutional rights and our team simultaneously works to expose investigator intimidation tactics and traps.

The sooner you contact us, the higher your chances of avoiding conviction. Tully & Weiss Law Firm has the resources, track record, experience, and determination necessary to provide the best defense to the charges you are facing. Our mission is to provide you with the best possible defense and clear your case so you can move on to continued success.

We represent clients throughout the state of California in both State and Federal court. On any given day our lawyers may be in San Francisco, Alameda or Contra Costa County, Sacramento, and all Northern California cities.