Irvine Health Care Fraud Attorneys

Protecting Your Rights in Both State & Federal Courts

Health care fraud is a crime that costs the United States billions of dollars a year. To combat the rise in fraud, federal and state agencies have set up task forces to identify and prosecute those committing fraud. Whether the agencies send out undercover investigators or interview patients, their aggressive approach needs to be met with an equally aggressive defense. At the Law Firm of Pilchman & Kay, P.L.C., we can provide you with tenacious Irvine fraud crime lawyers who have 30 years of combined experience defending thousands of clients in both state and federal courts. We have high negotiation skills and a proven track record of successfully resolving cases as early as pre-trial.

Understanding Health Care Fraud

Both federal and state courts prosecute health care insurance fraud claims. In addition, the California Medical Board also conducts their own investigations into fraudulent billing activities. Physicians, hospitals, laboratories, durable medical equipment companies, pharmacies, hospice care, and adult living facilities are all subject to the scrutiny of insurance fraud investigators.

Contact (949) 558-0042 immediately if you have been charged with or are being investigated by any federal or state agency for the following:

  • Billing for services not performed
  • Over-billing for services performed
  • Paying referral fees or giving or receiving “kick-backs”
  • Providing unnecessary procedures or surgeries
  • Billing higher than statutorily authorized
  • Capping

Health Care Fraud Penalties

Both federal and state statutes provide for stiff punishment for those convicted of health care fraud-related crimes.

Penal Code 550(a) PC prohibits most forms of healthcare and medical billing fraud in California:

  • For claims less than nine hundred fifty dollars ($950), it will be considered as a misdemeanor subject to imprisonment in a county jail for up to six months including paying a fine of not more than one thousand dollars ($1,000), or both.
  • For claims in excess of nine hundred fifty dollars ($950), the offense of health care fraud is a wobbler which means that it can be prosecuted as either a misdemeanor or felony.
  • If it is charged as a felony, the maximum penalties include a fine of up to fifty thousand dollars ($50,000) or double the amount of the fraud, and/or imprisonment for two, three or five years in custody.

In addition, the California Medical Board could place serious restrictions on your license while your case is being prosecuted.

Defenses to Health Care Fraud

Common defenses to health care fraud include lack of knowledge and lack of intent. In order to be convicted of health care fraud, it must be proved that you knowingly submitted fraudulent claims. This means that if you submit a claim in believing that it was a legitimate claim then you cannot be convicted of health care fraud.

Lack of intent means that while you may have billed for something you cannot bill, you did so without the intent to defraud medical insurance companies.

Interim Suspension Order

The California Medical Board, Dental Board, Nurses Board, Pharmacy Board can seek an interim suspension order (ISO) of your license during the course of an investigation or pending criminal matter. A conviction is not necessary.

An ISO would allow either an administrative law judge or superior court judge to place a total restriction or partial restriction on your license. A total restriction would prevent you from practicing until either a conviction, acquittal or determination by the board after hearing.

Contact an Irvine Fraud Crime Lawyer Today

Whether you are arrested or being investigated for health care fraud, hiring a skilled Irvine criminal defense attorney is crucial. You do not have to go through this alone. Let us utilize our decades of experience to helping you obtain the most favorable outcome possible.

Schedule a free consultation at (949) 558-0042 and discuss your health care fraud charges in Irvine.

A Winning Combination of Legal Abilities

  • We are backed by over 30 years of experience.
  • We have handled thousands of criminal defense cases.
  • We are fully certified by the State Bar of California.
  • We have repeatedly resolved cases during pre-trial.
  • We are backed by a professional background in prosecution and medical board defense.

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