Best Health Care Fraud Criminal Defense Attorney in California

In California, healthcare fraud is a broad term that includes a wide range of 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 creates an opportunity for 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 common 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” the insurance provider.

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

Elements of the Crime for California Health Care Fraud Cases

As discussed above, 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 that are 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.

Put simply, 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 the documents you prepared would be used to introduce a false claim.

Further, it must also be proven that you had a specific intent to defraud the medical insurance company or the insurance program. Just 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 at 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 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 things that are important to them.

If you or a loved one is charged with a healthcare fraud-related matter in Los Angeles, either at the state or federal level, you've come to the right place. 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 as it relates to health care. If anybody is taking 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, and that is taking the government's money unlawfully. Sometimes that's difficult for the government to prove; sometimes, it's easy for them 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 can't they do it as well.  What's the problem with it?

Developing a Strategy for Best Possible Outcome

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 to 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.

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:

Avoiding Jail Time in California Health Care Fraud Cases
  • 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.

Take the first step now.  Pick up the phone.  Set the meeting with Ron Hedding.  I stand at the ready to help you.  If you want the best, you've come to the right place. Hedding Law Firm is a Los Angeles criminal defense law firm and offers a free case review.