Healthcare fraud charges can ruin your career fast. They can also damage your reputation right away. Federal investigations move quickly. You need experienced legal help immediately. At Kenney Legal Defense, we understand the seriousness of these charges. We understand the significant impact they have on doctors, nurses, and other healthcare workers.
Our San Diego healthcare fraud attorneys have defended clients across California. We handle complex white-collar crime cases and have delivered proven results.
Our San Diego Healthcare Fraud Lawyers Defend Your Rights
Healthcare fraud cases involve tough state and federal laws. These cases need lawyers with special experience. Our team at Kenney Legal Defense has that experience. We defend healthcare professionals facing Insurance Fraud and Medicare Fraud charges.
We are familiar with both federal regulations and California law. We defend doctors, nurses, pharmacists, and other healthcare professionals. These cases often involve civil and criminal penalties. We fight to protect your license and your career. We also work to protect your reputation. Our attorneys push back against the Department of Justice. We are skilled in handling federal court proceedings.
What is Healthcare Fraud in California?
Healthcare fraud refers to the act of deceiving individuals or organizations to obtain money from insurance or government programs. In California, this includes billing for services never done or unnecessary procedures. These practices fall under laws like the False Claims Act and the Anti-Kickback Statute. They can lead to civil fines and jail time.
Common fraud schemes include phantom patients and drug diversion. Medi-Cal and Medicare are common targets. California Penal Code § 550 makes this type of fraud a serious offense. The government must prove the person knew they were committing fraud and planned it.
Common Healthcare Fraud Charges in San Diego
San Diego healthcare fraud charges include:
- Medicare billing fraud
- Prescription drug fraud
- Illegal Kickbacks
- Illegal referral fees from device companies
- Identity theft and credit card fraud
Agencies such as the FBI and the Economic Crimes Unit handle these cases.
Medicare and Medicaid Fraud
Medicare fraud involves false claims to the federal program. This includes charging for care that never happened. Common scams involve phantom patients and fake treatments. Medi-Cal fraud targets California's Medicaid program. These cases often result in substantial fines and even imprisonment. The U.S. Department of Health and Human Services investigates these matters. They may demand repayment and press charges against them. Convicted individuals face jail time and ruined careers.
Prescription Drug Fraud
This crime involves illegal drug distribution and misuse of prescriptions. Doctors may face charges for improper prescriptions. "Doctor shopping" refers to a patient obtaining prescriptions from multiple doctors. Pharmacists can also be charged for filling fake prescriptions. These cases may involve license suspensions and criminal charges. Federal lawyers play a crucial role in defending these charges.
Doctors and other providers can face charges for:
- Performing unnecessary procedures
- Faking medical records
- Inflating costs for workers' comp claims
Some malpractice and wrongful death cases also include fraud. These claims can ruin a healthcare career. Time limits for filing charges vary based on the court.
Penalties for Healthcare Fraud in San Diego
Healthcare fraud carries serious penalties:
- Misdemeanor or felony charges based on the case
- Prison sentences of up to 20 years or more
- Civil fines and restitution
- Loss of medical license
- Added penalties for related charges like money laundering
The Economic Crimes Division seeks the toughest penalties possible.
Legal Defenses Against Healthcare Fraud Charges
Strong legal defenses can reduce or dismiss healthcare fraud charges in San Diego. Lack of intent is the most common defense, as fraud requires specific criminal intent. Mistakes or error defenses show billing problems were unintentional. Entrapment occurs when government agents intentionally encourage or facilitate fraud. Good faith reliance on professional advice can be a valid defense. Statute of limitations defenses apply when charges are filed too late. Our Medicare fraud lawyer examines the government's case for weaknesses.
Lack of Intent
Healthcare fraud requires specific intent to defraud insurance companies or government programs. Lack of intent means the defendant didn't know their actions were wrong. It also means they didn't know their actions were fraudulent. Billing errors and coding mistakes happen frequently in busy medical practices. These mistakes are often completely innocent.
Our Federal criminal defense attorney shows that errors were honest mistakes rather than intentional fraud. Intent crime prosecutions must prove defendants acted knowingly and willfully. This is often very difficult for prosecutors to prove. Medical professionals often rely on billing staff who make unintentional errors. These staff members may not understand complex billing rules.
Mistake or Error
Medical billing and coding are extremely complex, with thousands of rules and regulations governing the field. Honest mistakes in claim for services submissions don't constitute criminal fraud. Even experienced billing staff make errors on a regular basis. Our legal team investigates billing procedures to show errors were unintentional. We carefully review training records and billing policies to ensure accuracy and compliance.
These records demonstrate good faith efforts to comply with regulations. Computer errors and software problems can cause incorrect billing automatically. Healthcare providers often discover and correct billing errors on their own. This shows they weren't trying to commit fraud. When people fix their own mistakes, it proves good faith.
Entrapment
Entrapment occurs when government agents induce healthcare providers to commit fraud. This happens when they encourage fraud that wouldn't normally occur. Undercover investigations sometimes cross the line into the territory of entrapment. The Violent Crime and Law Enforcement Act provides protections against overzealous government tactics.
Our attorneys examine all investigative techniques used against our clients. We look for signs that government agents went too far. Federal legislation requires proper procedures during fraud investigations. Government agents cannot create crimes just to make arrests. This violates constitutional rights and due process of law.
The Legal Process for Healthcare Fraud Cases in San Diego
Healthcare fraud cases follow a complex legal process. This process can take years to resolve completely. Civil investigations often begin before criminal charges are filed. The federal investigation involves multiple agencies, including the Federal Bureau of Investigation.
Grand jury proceedings may result in indictments for criminal charges. Pretrial motions challenge evidence and legal procedures. Plea negotiations can often resolve cases without the need for a trial. Healthcare fraud investigation procedures must follow constitutional requirements for valid prosecutions.
Investigation and Arrest
Healthcare fraud investigations often begin with whistleblower complaints. They also initiate investigations into suspicious billing patterns that catch the government's attention. Government agencies review medical records and billing data for indicators of potential fraud. Search warrants allow investigators to seize computers and financial records. Arrests typically occur after lengthy investigations and grand jury proceedings.
Miranda rights must be read during custodial interrogations. Our attorneys advise clients to exercise their right to remain silent during investigations. Anything you say can be used against you in court. It's always better to wait for your lawyer before speaking.
Pretrial Motions and Plea Deals
Pretrial motions challenge illegally obtained evidence and constitutional violations. Suppression motions can exclude crucial evidence from the trial. This often leads to better outcomes for defendants. Plea deals can significantly reduce charges or penalties.
Early plea negotiations often result in better outcomes for defendants. Our legal team evaluates all evidence before recommending plea strategies. Alternative sentencing options may include probation instead of prison time. We strive to achieve the best possible outcome for our clients.
Why Choose Our San Diego Healthcare Fraud Lawyers?
Kenney Legal Defense has successfully defended healthcare professionals against allegations of professional misconduct, including fraud. We have experience throughout San Diego County and beyond. Our consumer attorneys are well-versed in both the civil and criminal aspects of healthcare fraud law.
We work with medical experts to explain complex billing procedures to juries. Our personalized approach ensures each client receives dedicated attention and aggressive representation. We protect medical licenses and professional reputations whenever possible.
FAQ Section
What is considered healthcare fraud in California?
Healthcare fraud includes billing for services not rendered, phantom billing, and submitting false claims to insurance companies. Other examples include unnecessary procedures, drug diversion, and kickback schemes. California § 550 makes insurance fraud a serious crime with harsh penalties.
What penalties do I face if convicted of healthcare fraud in San Diego?
Healthcare fraud penalties include prison sentences of up to 20 years and enormous fines. Civil penalties can reach millions of dollars. You may permanently lose your medical license. Restitution requires paying back all fraudulently obtained money plus interest and penalties.
Can healthcare fraud charges be reduced or dismissed?
Yes, experienced attorneys can often reduce or dismiss healthcare fraud charges. Common defenses include lack of intent, billing errors, and constitutional violations. Early intervention and strong legal representation significantly improve the chances of favorable outcomes.
How can I prove my innocence if I've been charged with healthcare fraud?
Our attorneys investigate billing procedures and examine all evidence for weaknesses. We use expert witnesses to explain complex medical billing regulations. Lack of intent and honest mistake defenses often succeed in healthcare fraud cases.
What should I do if I'm being investigated for healthcare fraud?
Contact an experienced healthcare fraud attorney immediately. Don't speak with investigators without legal representation present. Preserve all documents and records related to your case. Exercise your constitutional right to remain silent during investigations.
Can I face jail time for a first-time offense involving healthcare fraud?
Yes, even first-time healthcare fraud offenses can result in prison time. However, experienced attorneys can often negotiate alternative sentences, such as probation. Early plea negotiations and cooperation can significantly reduce penalties for first-time offenders.
Contact Our San Diego Healthcare Fraud Lawyers for a Free Case Evaluation
Don't let healthcare fraud charges destroy your career and reputation. Kenney Legal Defense offers complimentary consultations to discuss your case and explore your legal options. Our experienced healthcare fraud attorneys are well-versed in the complex laws and regulations governing these cases. We provide aggressive legal representation that defends your rights. Contact us today to schedule a complimentary case evaluation with our experienced legal team. Time is critical in healthcare fraud cases, so don't wait to get the experienced legal help you need.