What Are the Penalties for Medicare Fraud in California?

Find Out (Today) Why California Healthcare Providers Hire Oberheiden, P.C. For Their Defense: 888-680-1745

It’s tough to run a medical business in California these days. It seems no day goes by without breaking news on arrests, search warrants, and indictments against physicians, mental healthcare providers, and California Medicare businesses. When it comes to protecting your business against unfair fraud allegations, you shouldn’t gamble with your license or livelihood. Consider speaking to attorneys with a proven track record of helping hundreds of healthcare providers like you, throughout California and beyond. Call today, free of charge at 888-680-1745. Oberheiden, P.C. attorneys have successfully represented:

• Mobile Ambulance Transportation Cases
• Mobile Radiology Services
• Home Healthcare Agency (Form 485 Cases)
• Hospice Care Representation
• Illegal Kickbacks
• Any Form of Medicare Fraudulent Billing
• Mental Healthcare Providers
• Cardiologists
• Urologists
• Dialysis Centers
• Dentists
• Family Medicine Doctors
• Internal Medicine Specialists
• Pain Management Doctors
• Psychologists
• Psychiatrists
• Medicare Clinic Owners
• Nurses

What Are the Penalties for Civil Medicare Fraud in California?

Federal prosecutors in California may prosecute unintentional Medicare violations as a civil case. In civil Medicare investigations, the government claims a Medicare provider submitted false claims to CMS, or 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 serious penalties beginning at more than $10,000 per violation (e.g. per submitted claim). These penalties have often been increased.

If your business receives a subpoena from the U.S. Attorney’s Office or the Department of Health and Human Services (HHS) about possible civil healthcare violations, call Oberheiden, P.C . right away. Our lawyers have had civil fraud allegations dismissed in most areas of the United States. This experience is needed to save your assets. Call us at 888-680-1745 and hear how we would protect your business and your assets.

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 the following elements are met.

• The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a healthcare benefit program or obtain money or property from a healthcare 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 healthcare benefit program; and

• The defendant acted with the intent to defraud the healthcare benefit program.

What Are the Penalties for Criminal Medicare Fraud in California?

Penalty calculation in California Medicare fraud cases is complex and depends on many factors. If you have questions or need guidance for an upcoming sentencing hearing, call Oberheiden, P.C. today for a free and confidential consultation. We are also available on weekends. Call 888-680-1745.

Federal Sentencing Guidelines, that federal judges use across the country, usually determine that the higher the damage to CMS/Medicare, the longer the sentence.

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.

• A California doctor was convicted by a federal jury for his role in a home health Medicare fraud scheme. According to trial evidence, the doctor referred his patients to a home health agency for illegal kickbacks. Each time the doctor referred a patient to the agency, he received a 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 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. An ambulance company coordinator is alleged to have altered the paperwork for dialysis patients in order to qualify them for transport. The indictment alleges that these dialysis patients did not qualify for ambulance transport under Medicare guidelines, and the coordinator intentionally fabricated the patients’ medical conditions 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. However, the lab allegedly ordered 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 involved in a Medicare fraud scheme. The fraud allegations relate to the urologist’s role in promoting and profiting from illegal referrals. The complaint alleges the urologists owned an imaging center and often referred their own patients to the center. The center would perform tests on the patients and the two urologists profited from the payment for these ordered tests. Since the urologists owned the imaging center, they shouldn’t have referred their patients 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 healthcare 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 healthcare fraud conspiracy.

Additional Pages for California

• California federal grand jury subpoena defense
• California workers compensation fraud defense
• California healthcare fraud defense
• California False Claims Act defense
• California hospice & home health fraud defense
• California medical license defense
• California Medicare fraud defense