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Health Care Fraud Defense in the State of California

Health care fraud can have several different meanings, depending on the party asked. For instance, for most health care providers, health care fraud can mean the deliberate attempt to somehow take funds from government benefit programs such as Tricare or Medicare. For federal agencies and prosecutors, health care fraud can have a much broader meaning. In legal terms, even unintended errors could lead to health care fraud allegations, which can carry possible financial penalties or the loss of government program eligibility.

If you are in the health care industry, it serves to be knowledgeable of what can constitute health care fraud in the eyes of the government. This article will highlight common examples that can lead to a civil or criminal charge. If you are being investigated or charged with health care fraud, seek the legal support of a trusted attorney that has experience in dealing with white-collar crime defense. An experienced attorney will study the case and provide you with the best possible solution for the charges against you.

Billing Errors

One of the most common matters that prompt federal health care scheme investigations are coding and billing errors. It is worth noting that these investigations can be initiated even if the incident occurs unintentionally. Health care providers that participate in government health care benefit programs typically receive reimbursements for certain medical-aid items and services. Coding and billing errors can be common and they can unfortunately sustain costly investigations. In order to establish culpability, federal authorities will require that the health care provider sustained knowledge or intent of the scheme.

False and Fraudulent Claims

One of the most powerful tools the government has to prosecute health care providers who are suspected of fraud is the Federal False Claims Act. This broad statute allows for federal feasibility on criminal charges for all false and fraudulent claims submitted for reimbursement. Fraudulent claim investigations can be initiated through one of two forms. The first is through direct initiative. Here, billing data will demonstrate an abnormal record that suggests the potential of false or fraudulent claims. The second form is through a whistleblower claim. That is, a private citizen who has information with regard to the violation files a claim under the United States Department of Justice, Office of Inspector General, or Department of Health and Human Services.

Billing for Unnecessary Medical Matters

When a medical provider seeks to be reimbursed for a medical matter, the matter in question will need to qualify as being medically necessary. Unfortunately, the term medically necessary can be ambiguous which can lead to different forms of interpretations.

Seek the Expert Advice of a Skilled Attorney for Health Care Fraud Charges

A health care fraud charge cannot only be lengthy and stressful; it can also lead to unnecessary expenses. Furthermore, the charge can also lead to a tarnished reputation, which can be detrimental for any private business. If you or your business is being charged with a health care fraud charge, seek the legal expertise of a qualified attorney as soon as possible.

The attorneys at Milligan, Beswick, Levine & Knox, LLP have extensive experience in dealing with white-collar crimes in the State of California. They are dedicated to ensuring that the rights of their clients are upheld. Health care fraud charges are a delicate matter; seek proficient support as soon as possible.

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Stephen Levine, is a Board Certified Specialist in Criminal Defense — an honor achieved by only the top criminal law attorneys in California. Mr. Levine has over 40 years of experience in criminal defense and family law serving Southern California, and is a highly regarded Super Lawyer as well as AV Rated attorney.