San Diego Criminal Lawyers Blog
This country faces a serious problem in terms of healthcare fraud, and authorities have not hesitated to impose serious consequences. As the most expensive white-collar crime in the country—racking up nearly $100 billion in lost funds — the state of California is more than willing to prosecute fraudsters. Both state and federal prosecutors, in fact, are going after individuals and organized groups who engage in this type of fraud on a daily basis.
Examples of Fraud
Fraud might occur involving individuals who work in hospitals, nursing homes, dentist offices, and more. Professionals and staff who try to cheat health insurance companies are a serious concern because there are multiple ways to engage in a swindle, and a successful fraudster can essentially steal big dollars and impact patient outcomes. Deliberately providing incorrect or false information to an insurance company is the bottom line of many fraud cases.
- Double billing insurance companies for a single procedure;
- Coding procedures in a way that makes billing more expensive;
- Charging for procedures and/or care to increase profits;
- Prescribing unnecessary medications and/or procedures in order to get kickbacks from pharmaceutical companies.
Legal Penalties
When the fraud involves under $950, offenders in California may face misdemeanor charges with up to six months in jail and fines of $1,000. Felony health care fraud, however, could mean up to five years behind bars and as much as $50,000 in penalties, or double the amount of the fraud. In the case of medical professionals being convicted, they could lose their professional license. Federal penalties are dependent on the degree of injury that occurs to a patient. Even with no injuries, perpetrators could wind up serving 10 years behind bars. That doubles when serious injury results from the fraud and becomes a life sentence if the fraud results in a fatality.
Federal False Claims Act
Any person or entity who knowingly submits a sham claim for Medicare, Medicaid, or other federally funded programs or who intentionally retains an overpayment for 60+ days is in violation of the federal False Claims Act. In addition to having to pay triple the damages suffered by the Government, perpetrators may have to pay nearly $22,000 per falsified claim.
Defending Fraud Claims
One of the strongest defenses against claims of healthcare fraud is to demonstrate that any perceived billing irregularities were the result of misunderstandings and/or unintentional mistakes. Demonstrating that patients received legitimate care consistent with billing will be important, as will establishing a pattern of providing high-quality care aimed at patient well-being.
An Aggressive Defense
If you are facing charges of health care fraud, the experienced criminal defense attorneys at Boertje & Associates are prepared to put forth a vigorous defense on your behalf. To discuss the particulars of your situation, schedule a confidential consultation in our San Diego office today.