Federal Crimes Blog

What Makes Health Care Fraud a Federal Crime?

Posted by Hedding Law Firm | Jun 12, 2020

What Are Some Examples Of Charges Brought Under Health Care Fraud By A Consumer, Patient, Or A Doctor?

When it comes to health care fraud, especially at the federal level, the government is sending a benefit to somebody that shouldn't be getting that benefit. For example, maybe a doctor is billing Medicare or Medicaid improperly.

By doing so, they're getting a lot of money from the government while no patient is receiving treatment. Also, if they were splitting the profits with the patient, or the patient knew that the government agency was being improperly billed, they could go after the patient as well.

In Los Angeles, the government has an office in Long Beach that goes after employees who are milking the health care system out of money. This agency is a federal branch and arm of the federal government that is tasked with going after people who are committing health care fraud in Los Angeles, Orange County, and the surrounding areas.

Those crimes go to the central district or main downtown Los Angeles courthouse on 1st Street. There is also the Ronald Reagan Building in Santa Ana.

Health care fraud is prosecuted at the federal level across the country. The government is losing millions of dollars in people committing fraud related to health care, whether it be doctors, patients, or individuals who are working to try to cheat the government out of money.

Unfortunately, sometimes the government gets it wrong. They don't realize that you specifically didn't have anything to do with it, or that the services that were 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 put together that health care fraud was being committed at the federal level.

What Makes Health Care Fraud Charges Federal Offenses?

Technically, any time health care fraud or theft occurs in the United States, it is a federal offense. Since goods are coming from the federal government, it's likely the primary reason why the feds can prosecute health care fraud.

What Makes Health Care Fraud a Federal Crime?

However, the states also prosecute health care fraud. If the state government is giving money for health care in any way, they'll typically come in and prosecute.

But if federal funds are involved, the federal government, as it relates to health care fraud, has specific units set up to make sure that those funds are not being stolen or improperly handled.

If they don't, they would be putting themselves in a position where the health care system would break. A lot of money already goes into the health care system from the federal government, and so, they need to protect that money to ensure that those funds are given to people who really need it.

The main reason why the feds take these cases is because it's their money that's 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. And as mentioned, they have a special unit in the Long Beach that specifically investigates federal health care 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 health care 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 time unless they have all of the information they need 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 that should have reasonably known what was happening, you could be prosecuted.

For instance, if you're the one that does the billing, and you can see that the government's being billed 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 can see that they're not doing anything legitimate, you're complicit in that you aided or looked the other way, and you could be prosecuted as well. If anybody sees fraud occurring, they need to report it or quit that job.

You can't continue to work and help cheat the government out of money because you will be prosecuted along with the others involved in the scheme.

In fact, one of the strategies that the feds use in investigating health care fraud cases is scaring employees to death. In turn, the employee start talking and give information against the higher-ups, who are the ones that are really responsible.

They're the ones that are making the most money from health care fraud. But the feds go after the employees very aggressively to try to get them to testify against the doctors or individuals making the real money as it relates to health care fraud.

Sentencing Guidelines Under Federal System For Health Care Fraud Convictions

The sentencing for health care fraud convictions depends on the type of health care fraud committed. They usually charge health care fraud with the United States code sections at the criminal level. Each of those code sections have a base offense level.

Then, there are special enhancement or characteristics related to those particular charges that can up the amount of points that you get related to the sentencing guidelines.

For example, the biggest factor is the amount of money that was taken from the government. Was it a couple of thousands, was it 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 might do 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's still not 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 health care 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 health care 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 in both the criminal and administrative level

A lot of times, I will work hand-in-hand with my clients and the administrative attorney who is defending them at the medical board level. I share information and evidence with them.

If the doctor indicates that they're innocent, then we're going to 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 is going to be heard at that level.

On the other hand, if they have proof that you did something criminal, and you're criminally convicted, that conviction is going to impact your medical license. Either the federal judge or 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 alternate solution that they will deem appropriate under the circumstances.

Hedding Law Firm is a top-ranked criminal defense law firm in Los Angeles at 16000 Ventura Blvd #1208 Encino, CA 91436. We also have an office at 633 West Fifth Street Los Angeles, CA 90071. Contact our office for a free case evaluation at (213) 542-0994.

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