Healthcare fraud, especially at the federal level, is a serious issue. It involves the government providing benefits to individuals who are not eligible to receive them. For instance, a doctor might improperly bill Medicare or Medicaid, resulting in significant financial losses.
By doing so, they're receiving a significant amount of money from the government while no patient is receiving treatment. Additionally, if they were splitting the profits with the patient or the patient knew that the government agency was being improperly billed, they could also go after the patient.
In Los Angeles, the government has an office in Long Beach that targets employees who abuse the healthcare system for personal gain. This agency is a federal branch and arm of the federal government, tasked with investigating individuals who commit healthcare fraud in Los Angeles, Orange County, and surrounding areas.
Those crimes are handled by the central district or the main downtown Los Angeles courthouse, located on 1st Street. The Ronald Reagan Building is also in Santa Ana.
Healthcare fraud is prosecuted at the federal level nationwide. The government is losing millions of dollars to individuals committing healthcare-related fraud, including doctors, patients, and those working to cheat the government out of money.
Unfortunately, sometimes the government gets it wrong. They don't realize that you specifically had nothing to do with it or that the services being rendered were cheating the government out of money.
You were just doing your job and didn't have the knowledge or information necessary to determine that healthcare fraud was being committed at the federal level.
What Makes Health Care Fraud Charges Federal Offenses?
Technically, any instance of healthcare fraud or theft in the United States is a federal offense. Since goods are coming from the federal government, this is likely the primary reason why the feds can prosecute healthcare fraud.
However, states also prosecute healthcare fraud. If the state government is providing money for healthcare in any way, they'll typically come in and prosecute.
However, if federal funds are involved, the federal government has specific units in place to prevent healthcare fraud and ensure that federal funds are used for their intended purpose. These units are responsible for investigating, prosecuting, and preventing health care fraud.
If they don't, they would be putting themselves in a position where the health care system would break. A significant amount of money is already allocated to the healthcare system by the federal government. Therefore, they need to protect that money to ensure that the funds are given to those who truly need them.
The main reason the feds take these cases is that it's their money that has been stolen. If you're taking federal money, expect the federal government to come after you. They have federal prosecutors who deal with these cases. As mentioned, they have a special unit in Long Beach that specifically investigates federal healthcare fraud.
Can I Be Charged With Health Care Fraud If I Had No Direct Involvement?
If you work in an office that is being investigated for healthcare fraud, the feds will swoop in and grab all the records related to whatever you're working on. Most of the time, they don't make any arrests at that point unless they have all the necessary information to make an arrest.
They will just take the information. For example, if you're working in a doctor's office, hospital, or another location that is accepting federal funds related to health care, you would have to be complicit in fraud. In other words, you would have to know or reasonably know, under the circumstances, that fraud is being committed.
People often argue that they didn't know what was going on. However, if you are in a position where you should have reasonably known what was happening, you could be prosecuted.
For instance, if you're the one who does the billing and you can see that the government is being billed for certain things that are not being done to patients or that you didn't even have particular patients, but your company is receiving funds, you are part of the cog that is illegally taking the money.
If you witness fraudulent activities, it's crucial to report them or consider leaving the job. By taking action, you can prevent further losses and protect the integrity of the healthcare system.
Continuing to work in a fraudulent system can lead to severe consequences. If you're complicit in cheating the government, you could face prosecution along with others involved in the scheme.
In fact, one of the strategies that the feds use in investigating healthcare fraud cases is scaring employees to death. In turn, the employees start talking and giving information to the higher-ups, who are really responsible.
They're the ones making the most money from healthcare fraud. Still, the feds aggressively pursue the employees in an attempt to get them to testify against the doctors or individuals who are actually profiting from healthcare fraud.
Sentencing Guidelines Under the Federal System For Health Care Fraud Convictions
The sentencing for healthcare fraud convictions depends on the type of healthcare fraud committed. Healthcare fraud is typically charged under United States Code sections at the criminal level. Each of those code sections has a base offense level. The severity of the offense, the amount of money involved, and the number of victims impacted are all factors that can influence the sentencing guidelines for healthcare fraud convictions.
Then, special enhancements or characteristics related to those particular charges can increase the number of points you get related to the sentencing guidelines.
For example, the most significant factor is the amount of money allocated from the government. Was it a couple of thousand, millions, or somewhere in between?
That's really where you start to get down to the nitty-gritty as far as punishment is concerned. The more money that was taken, the more time in federal custody you will face.
The more victims that were impacted, the more time in federal custody you will face. And, the more sophisticated the operation, the more likely the judge and prosecutor will view you as somebody who needs to be seriously punished.
Another factor that relates to how much time you spend is the position you sit in. In other words, if you're a doctor milking the federal government out of millions of health care dollars, you can expect to get a very stiff sentence versus someone who's an employee getting paid the same amount.
Whether or not the government gets cheated, it still needs to be right. And, if they can prove that you knew about it and helped, you could be prosecuted. But an employee is not going to be punished anywhere near what a doctor would.
Will a Physician Charged With Health Care Fraud Lose Their Medical License?
A medical license goes hand-in-hand with a practice. If you're committing healthcare fraud in your practice, you are susceptible to losing your medical license. The first thing you have to evaluate is whether they have the evidence to prove that you committed a criminal healthcare fraud violation.
If they don't, and your federal criminal defense attorney can defend you and show that you're innocent, you're not going to lose your medical license. The medical board is entitled to have a hearing, but the same defense that would be used to defend you in a criminal case can be used to defend you at the medical board level. If you're innocent, you're innocent at both the criminal and administrative levels.
I often work closely with my clients and the administrative attorney who represents them at the medical board level. I share information and evidence with them.
If the doctor indicates that they're innocent, we'll set about proving that to the jury at the federal criminal level. I will also assist in the medical board investigation and at the hearing that will be held at that level.
On the other hand, if they have proof that you did something criminal and you're criminally convicted, that conviction will impact your medical license. Either the federal judge or the medical board will impose restrictions on your medical license after the conviction.
A conviction will result in the revocation of your medical license, suspension, or an alternate solution that they will deem appropriate under the circumstances.
Hedding Law Firm is a top-ranked criminal defense law firm in Los Angeles. Our office is located at 16000 Ventura Blvd, #1208, Encino, CA 91436, and 633 West Fifth Street, Los Angeles, CA 90071. For a free case evaluation, please call (213) 542-0994.
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