California Medicaid Fraud Defense

Experienced Defense Counsel for California Healthcare Providers and Others Targeted for Suspected Medicaid Fraud

Medicaid fraud allegations can lead to serious healthcare fraud charges for providers in California. Other entities and individuals can face civil or criminal charges as well. If authorities are targeting you, your business, or your practice, you need a team of highly experienced healthcare fraud defense lawyers on your side.

From Los Angeles County to San Francisco, healthcare providers across California are being targeted in Medicaid fraud audits and investigations. Medicaid fraud enforcement has become a top priority for the federal government in recent years, and facing Medicaid-related scrutiny can expose entities and individuals to substantial risks—including the risk of facing federal criminal charges in some cases.

If you are under investigation or facing charges involving alleged Medicaid fraud (or Medi Cal fraud), it is imperative that you engage experienced defense counsel promptly. This is a high-risk scenario that can lead to civil penalties or criminal prosecution. Several federal and state laws prohibit a wide range of fraudulent practices related to Medicaid, and targets need experienced legal counsel who can defend them by all means available.

The Federal Government is Targeting Medicaid Providers in California

For targeted healthcare providers (and other individuals and entities), one of the primary risks of facing Medicaid-related scrutiny is the risk of facing federal charges. The U.S. Attorney’s Offices for the Central, Eastern, Northern, and Southern Districts of California are all actively pursuing Medicaid fraud cases—including criminal cases involving serious federal charges. Some examples of common allegations in these cases include:

• Anti-Kickback Statute and Stark Law violations involving illegal kickbacks, referral fees, and other forms of remuneration
• Billing Medicaid for unnecessary medical services (or “medically unnecessary services” under the Medicaid billing guidelines)
• Upcoding, unbundling, submitting multiple claims and other common fraudulent Medicaid billing practices
• Submitting false claims for prescription medications (including prescription drug diversion and other forms of prescription drug fraud)
• Submitting false statements and forged documentation to support fraudulent claims for Medicaid reimbursement

State authorities are pursuing criminal and civil investigations involving suspected Medi Cal fraud as well. Similar to federal inquiries, these state-level investigations pose various risks; and, here too, targets need to rely on the advice and representation of experienced defense counsel. Whether you are facing scrutiny from state or federal authorities in California, our law firm can help.

Risks in California Medicaid Fraud Audits and Investigations

In all cases, California Medicaid fraud audits and investigations pose substantial risks. When you schedule a confidential consultation with a California Medicaid fraud defense attorney at Oberheiden P.C., one of our attorneys will be able to assess the specific risks you are facing based on the circumstances at hand.

Some examples of potential risks include:

False Claims Act Penalties

The federal False Claims Act imposes significant penalties for submitting any “false or fraudulent claim” for reimbursement under a government healthcare benefit program. This includes submitting fraudulent claims under Medicare, Medicaid, and Tricare. Hospitals, clinics, nursing homes, pharmacies, and medical professionals targeted under the False Claims Act can face financial penalties including:

• Civil monetary penalties (CMP)
• Criminal fines
• Recoupments
• Treble damages
• Costs and attorneys’ fees

Facing health care fraud allegations under the False Claims Act can lead to other serious penalties as well. For example, in Medicaid fraud cases, allegations of fraudulent billing can lead to:

• Denial of pending Medicaid reimbursement requests
• Pre-payment review of future claims
• Suspension of Medicaid billing privileges
• Increased risk of facing future audits and investigations
• Loss of Medicaid eligibility and exclusion from other government healthcare programs

For healthcare providers that hold a professional license, facing Medicaid fraud allegations under the False Claims Act can also lead to professional disciplinary action. As a result, for targeted medical professionals, it is critical to engage defense counsel who can assist not only with protecting their ability to bill federal programs (and Medi Cal), but with protecting their ability to practice as well.

Anti-Kickback Statute and Stark Law Penalties

Similar to the False Claims Act, the Anti-Kickback Statute also includes provisions for both civil and criminal enforcement—and Anti-Kickback Statute violations involving Medicaid will generally constitute False Claims Act violations as well.

The Stark Law (also commonly referred to as the Physician Self-Referral Law) is exclusively a civil statute. But, penalties for engaging in prohibited physician self-referrals related to Medicare and Medicaid patients can be substantial; and, here too, targeted providers may also be at risk of facing charges under the False Claims Act and other federal laws.

Criminal Charges for Healthcare Fraud and Related Offenses

Along with facing penalties under the False Claims Act, Anti-Kickback Statute, and Stark Law, targeted providers (and other entities and individuals) can face criminal charges under other state and federal statutes as well. For example:

• The federal healthcare fraud statute (18 U.S.C. Section 1347) allows for criminal prosecution in cases involving all forms of Medicaid fraud.
• California Penal Code Section 550 allows for state-level prosecution in cases involving allegations of submitting false claims under Medi Cal.
• Various other federal and state laws allow for criminal prosecution in cases involving allegations of attempted Medicaid fraud, conspiracy to commit healthcare fraud, money laundering, and related offenses.

Targeted providers can face fines, exclusion from government healthcare programs, prison time, and other penalties following fraud convictions under these statutes. As a result, California providers facing prosecution for alleged fraud need to be prepared to defend themselves by all means available.

Our Former Federal Prosecutors and Federal Investigators Have Extensive Experience in Medicaid Fraud Cases

At Oberheiden P.C., our team relies on extensive experience to defend healthcare providers and other entities and individuals facing Medicaid fraud allegations in California. We handle Medicare fraud cases and other state and federal healthcare fraud cases as well. Depending on the specific allegations at hand, some examples of defense strategies we may be able to execute on your behalf include:

• Providing documentation of medical necessity in cases involving allegations of billing for medically unnecessary services
• Providing documentation of compliance with the complex billing rules under Medicaid (or Medi Cal)
• Challenging the methodology of the audit that resulted in the allegations at hand or exposing issues with federal agents’ investigative tactics or practices
• Demonstrating compliance with applicable safe harbor regulations in Anti-Kickback Statute and Stark Law cases
• Disputing allegations of criminal intent in order to prevent prosecutors from proving your guilt beyond a reasonable doubt (demonstrating lack of intent can be a key defense strategy in criminal cases)

We have a proven track record of providing effective defense representation in Medicaid fraud cases, and we take a proactive approach focused on favorably resolving our clients’ cases as early in the legal process as possible. In Medicaid fraud cases, early intervention is key—and, by intervening early in the process, we are frequently able to resolve our clients’ cases without formal charges being filed.

FAQs: Defending Against a State or Federal Healthcare Fraud Investigation Under Medicaid

Contact the California Medicaid Fraud Defense Team at Oberheiden P.C.

To learn more about our experience in Medicaid fraud cases and how we can help with your case in California, contact us today. Call 888-680-1745 or contact us confidentially online to speak with a member of our California Medicaid fraud defense team in strict confidence as soon as possible.