What Are the Penalties for Medicare Fraud in California?
Find Out (Today) Why California Health Care Providers Hire Oberheiden, P.C. For Their Defense: 866-Hire-Nick
It is tough to run a medical business in California these days. Almost no day goes by without breaking news about doctor arrests, search warrants, and indictments against physicians, mental health care providers, and California Medicare businesses. When it comes to protecting your business against unfair fraud allegations, you should not gamble with your freedom or your license. Consider speaking to attorneys with a proven track record of helping hundreds and hundreds of health care providers, like you, throughout California and beyond— call today and free of charge at 866-Hire-Nick. Oberheiden PC attorneys have successfully represented:
- Mobile Ambulance Transportation Cases
- Mobile Radiology Services
- Home Health Care Agency (Form 485 Cases)
- Hospice Care Representation
- Illegal Kickbacks
- Any Form of Medicare Fraudulent Billing
- Mental Health Care Providers
- Dialysis Centers
- Family Medicine Doctors
- Internal Medicine Specialists
- Pain Management Doctors
- Medicare Clinic Owners
What Are the Penalties for Civil Medicare Fraud in California?
Federal prosecutors in California may prosecute unintentional Medicare violations as a federal civil case. In civil Medicare investigations, the government claims that a Medicare provider submitted false claims to CMS, violated Stark Law or the Anti-Kickback Statute. Many of these allegations stem from a whistleblower complaint filed under the federal False Claims Act.
If found liable, a Medicare business can face draconian penalties beginning at more than $ 10,000 per violation (e.g. per submitted claim). These penalties were increasingly even further lifted.
If your business received a subpoena from the U.S. Attorney’s Office or the Department of Health and Human Services informing you about possible civil health care violations, call Oberheiden PC right away. Oberheiden PC lawyers have dismissed civil fraud allegations in almost the entire United States, an experience needed to save your assets. Call us at 866-Hire-Nick and see how we would protect your business and your monies.
What Does the Government Have to Prove in a California Medicare Fraud Case?
Medicare Fraud is regulated in 18 U.S.C. 1347 and requires the government to prove, beyond a reasonable doubt, that all of the following elements are met.
- The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a health care benefit program or obtain money or property from a health care benefit program by means of false or fraudulent pretenses, representations, or promises;
- The defendant executed or attempted to execute the scheme or plan in connection with the delivery or payment of benefits, items or services under the health care benefit program; and
- The defendant acted with the intent to defraud the health care benefit program.
What Are the Penalties for Criminal Medicare Fraud in California?
Penalty calculation in California Medicare Fraud cases are complex and depend on many factors. If you have questions or need guidance for an upcoming sentencing hearing—then call Oberheiden PC today for a free and confidential consultation. We are available on weekends. Call 866-Hire-Nick.
Penalties for Medicare Fraud can be severe. A convicted defendant, as the following examples show, is subject to up to 10 years imprisonment per count, CMS exclusion, and financial penalties. In general, the Federal Sentencing Guidelines, which guide federal judges across the country including in California Medicare Fraud cases, determine that the higher the damage to CMS/Medicare, the higher the sentence.
- A California doctor was convicted following a federal jury trial for his role in a home health Medicare fraud scheme. According to evidence presented at trial, the doctor would refer his patients to a home health agency located in California for illegal kickbacks. Every time the doctor referred a patient to the agency, he would receive a cash payment via check. Based on these illegal referrals, Medicare paid out over $4 million. The doctor was convicted of one count of conspiracy to pay and/or receive kickbacks for Medicare referrals and four counts of receiving kickbacks for Medicare referrals.
- An employee of an ambulance company in California was charged for his role in a Medicare fraud scheme. The employee worked as a coordinator for the ambulance company and is alleged to have altered the paperwork for dialysis patients in order to qualify them for ambulance transport. The indictment alleges that these dialysis patients did not qualify for ambulance transport under Medicare guidelines, and the coordinator intentionally fabricated medical conditions of these patients to qualify them for services. As a result of this alleged scheme, Medicare paid out almost $7 million in claims.
- A lab in San Diego was charged in connection with a Medicare fraud scheme and has agreed to a monetary settlement to dispose of the case. The lab allegedly billed Medicare for medically unnecessary tests to diagnose breast cancer. The tests were only supposed to be ordered for patients who were in remission from breast cancer, and the lab allegedly ordered the tests for patients regardless of whether they were in remission or not. As a result of the agreed settlement, the lab will pay $2 million back to Medicare. Since this case ended with a settlement, there has been no finding of liability against the lab.
- Two urologists in California have agreed to settle allegations that they were in involved in a Medicare fraud scheme. The fraud allegations relate to the urologist’s role in promoting and profiting from illegal referrals. The complaint against the urologists alleges the urologists owned an imaging center and would often refer their own patients to this imaging center. The center would perform tests on the patients and the two urologists would profit from the reimbursement of these ordered tests. Since the urologists owned the imaging center, they could not refer their patients there as this is a violation of the Stark Law. The urologists will pay $1 million back to Medicare in order to settle these allegations.
- A California dentist was indicted for his role in a Medicare fraud scheme. The indictment alleges that the dentist billed Medicare for procedures that were never performed. The dentist allegedly billed Medicare using patient information without the patient’s permission. The dentist has been charged with six counts of health care fraud and 2 counts of identity theft.
What Is the Statute of Limitations for Medicare Fraud in California?
In California criminal Medicare fraud investigations, the Statute of Limitations is typically five years. However, 18 U.S.C. 3282 is subject to various exceptions that can prolong the allowable prosecution phase, in particular if the case is charged as a federal health care fraud conspiracy.