Will I Go to Jail If Charged with Health Care Fraud in California?

California Penal Code 550(a) PC prohibits most health care and medical billing fraud. In California, healthcare fraud is a broad term frequently called insurance fraud, medical billing fraud, Medicare fraud, or Medi-Cal fraud.

Most patients pay their health care expenses through either a private insurance company or government medical insurance. Since making health care payments is complex, it is much easier to commit fraud. Some of the most common schemes that violate Penal Code 550(a) PC heath care fraud laws include the following:

  • submitting false health care claims,
  • preparation of a document in support of a false claim,
  • submitting multiple claims for the same procedure,
  • billing for services that a patient never received,
  • billing for more expensive services a patient did receive.

For a prosecutor to obtain a conviction for health care fraud, they will have to prove, beyond any reasonable doubt, that you knew the claim was false or fraudulent and that you had a specific intent to defraud the medical insurance company or the insurance program.

What Primary Factors Are Prosecutors Looking At?

Whenever it comes to messing around with government money, stealing from the government in the form of something related to healthcare fraud, you can bet the prosecutors and judge on your case are going to be looking to punish you in kind for what you did:

  • They're going to look at the amount of health care fraud involved;
  • They're going to look at the sophistication level;
  • They're going to look at how many victims there were, and
  • they're going to formulate a plan to try to put you away for as long as possible.

These health care fraud schemes can often be prosecuted at either the state or federal level, depending on the sophistication, how much money was involved, and who was involved. Suppose you're talking about doctors being involved or lawyers being involved. More than likely, that case will go federal, and they're going to be looking to put the person away in federal prison at an 85% rate of the time they're doing. So, you can see that these cases are handled very harshly by the best prosecutors.

Defending California Health Care Fraud Cases

So, if you're looking to defend yourself, you'll want to get the best criminal defense attorney on your side.  I've been doing this now for almost three decades.

Health Care Fraud Laws in California - Penal Code 550(a)

I've seen how they prosecute healthcare fraud cases in Los Angeles.  I've seen how judges evaluate instances when formulating what they're going to do in their decision-making process.

I've defended cases at the federal level.  I've defended cases at the state level.  I've handled thousands of healthcare fraud-related cases in LA county for many years. The first thing I have you do is come to my office, sit down, and go over everything.

I need all the details from you — the stuff that helps your story and the stuff that might hurt your account — that way, I have all the pieces of the puzzle, and I can best figure out what the best game plan is for you, your circumstances if you're charged with healthcare fraud in California.

Once we've got that plan together, then we're going to start talking about what you're looking at, what you're facing, what you can do to help me so you can end up with the best result, and what I'm going to do for you moving forward in your case.

Health Care Fraud Prosecutors in Los Angeles

Healthcare fraud is treated very seriously because there are thousands of dollars — millions of dollars — at stake when you look at the whole healthcare system. So, if people steal money from the government, stealing thousands of dollars — and many people are doing it, it will break the system.

It will cause the system to collapse, and that's why the feds have put an office in LA county.  All they do is prosecute health care fraud cases.  The District Attorney's office in Los Angeles County has healthcare fraud prosecutors. They've got a separate section with a head prosecutor, an assistant prosecutor, and many deputies that go after people who commit healthcare fraud.

Best Health Care Fraud Criminal Defense Attorney in California

In California, healthcare fraud is a broad term that includes many misdemeanor and felony crimes, including medical billing fraud, insurance fraud, and Medicare or Medi-Cal Fraud.

Most patients pay for their health care using a private insurance company or a government-run medical insurance program. The routine procedure for processing payments related to health care is often complex, which creates the opportunity for someone to commit fraud.

This complex medical billing processing also allows entirely innocent patients to face criminal health care fraud accusations when they commit an honest mistake. While America's health care system is often the primary topic of discussion and debate, most people will agree that it's complicated and confusing.

For example, a routine annual checkup with your family doctor often includes a requirement to complete many forms. On the flip side, the physicians also have paperwork to complete, and their patient billing is based on actuary tables. Our Los Angeles criminal defense lawyers provide a review below for more information.

What are Common Types of California Health Care Fraud?

Some people make a living creating new fraudulent schemes, but there are many types of everyday health care fraud criminal conduct, including:

  • doctor's billing for medical services patient never received;
  • patient or doctor submitting false or fraudulent claims;
  • health care clinics billing for more expensive services than the patient received;
  • health care professionals are submitting duplicate billing claims for the same procedure.

California Penal Code 550 PC is the ordinary statute used by prosecutors to file charges against someone who submits a claim for health care procedures that were never actually performed, a prevalent type of insurance fraud.

Yet another standard fraudulent health care fraud scheme under PC 550 is when multiple claims are submitted for the same medical service, called “double billing,” by the insurance provider.

In most cases, health care providers face criminal charges, such as physicians, nurses, clinics, and therapists.

Elements of the Crime for California Health Care Fraud Cases

The doctors and clinics make honest mistakes with so much paperwork and confusion, but many are intentional acts of health care fraud for financial gain.

Best Health Care Criminal Defense Attorney in California

For a prosecutor to convict someone of health care fraud, they will have to prove some critical factors called by the legal profession the “elements of the crime.” These factors have to be proven beyond any reasonable doubt:

  • defendant knew the health care claim was false or fraudulent;
  • defendant had a specific intent to defraud.

You can't be convicted of health care fraud unless the prosecutor can prove that you knew the claim you were submitting was fraudulent or a duplicate claim or that the documents you prepared would be used to introduce a false claim.

Further, it must also be proven that you intended to defraud the medical insurance company or the insurance program. Like most all fraud-related crimes in California, the primary factor that must be proven is “intent.” If your criminal defense attorney can create reasonable doubt on this crucial element, you stand a better chance of avoiding a conviction.

Punishments for a Health Care Fraud Conviction

The penalties for a health care fraud conviction can be harsh. Most cases involve a loss of over $950, which can be filed as either a misdemeanor or a felony offense (wobbler).

If you are convicted of felony health care fraud, the penalties include:

  • two, three, or a five-year sentence in county jail;
  • fines up to $50,000 or double the amount of fraud;
  • probation that includes up to one year in county jail.

If the defendant is a doctor or health care professional, they will be subjected to having their professional license suspended or revoked. Related crimes for Penal Code 550 PC health care fraud in California include Health and Safety Code 11173 prescription fraud and workers' compensation fraud.

How to Get the Best Result in Health Care Fraud Cases

I've been defending those individuals charged with health care fraud now for almost three decades in all of the Los Angeles County criminal courts at the state and federal levels. To be the best:

  • you have to understand the crime;
  • you have to understand why the government prosecutes it;
  • you have to understand how to defend it, and
  • you have to understand if your client is guilty of the crime;
  • how to get the best resolution possible under the circumstances;
  • how to protect their rights, freedom, reputation, and all the important things to them.

You've come to the right place if you or a loved one is charged with a healthcare fraud-related matter in Los Angeles, either at the state or federal level. Your first move should be to pick up the phone and ask for a meeting with Ron Hedding. I've been doing this for a long time and have had a lot of success for my clients.

You have to understand that the government is very similar to the mafia-related to health care. If anybody takes government funds, the government will make sure that you're taking them lawfully.

If you are either a doctor, someone who works in the healthcare profession, a nurse, or anybody connected to healthcare in Los Angeles, you'd better not be taking money from the government that does not belong to you. That's the primary premise behind these health care fraud cases.

People are using Medical and Medicare. I've represented drivers; I've represented doctors, pharmacists, nurses — the list goes on and on and on. They all have one common threat to them: taking the government's money unlawfully. Sometimes that's difficult for the government to prove; sometimes, it's easy to prove.

Sometimes people don't understand why they're being prosecuted.  They think it's somebody else's responsibility, and they see other people doing it, so they figure out why they can't do it.  What's the problem with it?

Developing a Strategy to Fight Health Care Charges

So, that's one of the first things we have to sit down in a confidential environment and discuss:

  • number one, what did you do that's causing the government to either investigate or prosecute you for healthcare fraud?
  • number two, is what you did unlawfully?

Sometimes that requires some digging. We will look at what California Penal Code Section they are trying to say you violated. Once we have that, we can compare that to the facts and circumstances surrounding your case and determine whether or not you've done something wrong.

If you haven't done something wrong, then it's my job to convince the government you didn't do anything wrong and either not file a criminal case against you or dismiss the criminal case they have pending against you. And finally, if the government won't do those two things and you're innocent, we'll go to jury trial and beat the government.

Sometimes it's going to be a situation where you're getting swept up by a net, and you're innocent.  Other times, it's going to be a situation where you're guilty, and they've got the evidence, but maybe they're not looking at the case the right way.

Maybe they think that you're more involved than you are.  Other times, they'll have it exactly right, but that doesn't mean that the sentence and the punishment will be the same every time.

Criminal Defense for California Health Care Fraud Cases

It would help if you had someone who would fight for you.  You need someone going to go to bat for you and figure out what can be done to get you the result you must have — not just for you, but for your family and your future.

For example, do you want to go into custody for three to five years, and then you can't pay the money back because you can't work? The prosecutors will consider this.  If you can get that money upfront to pay them back, whatever it is you're involved with, you're now in a good position.  You currently have some leverage.

If you have no prior criminal record, never been in trouble before, you've got some leverage.  If you've got a great criminal defense attorney by your side, you've got some power because that attorney will figure out what it takes to get the result you must have.

So, first, you need to dissect the problem, then examine how you're going to attack it, and finally, you and your attorney working together need to put together a plan that puts you in the best possible position.

If, on the other hand, they're able to prove that you did commit some form of healthcare fraud, then we're going to have to:

  • figure out what we can do to keep you out of jail/prison;
  • protect your freedom;
  • protect your rights;
  • protect your reputation and your family, and
  • all of the things that are important to you.

That's why we'll sit down in that first meeting and, number one, decide where we stand; and number two, come up with a plan moving forward to get you out of the criminal justice system as fast as possible.

Check out my reviews on the internet.  Check out the videos that I've put out there so people can see who I am and what I'm all about, and then pick up the phone and set the meeting with Ron Hedding.  I stand at the ready to help you.

So, with that type of organization lined up against you, act immediately if you or a loved one is charged or being investigated for healthcare fraud.  Take the first step.  Pick up the phone.  Ask for a meeting with Ron Hedding. Hedding Law Firm is based in Los Angeles County at 16000 Ventura Blvd #1208 Encino, CA 91436. Contact our office for a free consultation at (213) 542-0940.