Medicare Fraud charges in California can arise when doctors or other medical professionals engage in fraudulent billing practices for medical services.  On Tuesday, May 13, 2014, the federal government arrested over 90 people involved in a nationwide medicare fraud scheme involving doctors and others from New York to Los Angeles.  Approximately 50 people alone were arrested and charged with fraudulent billings for home health care, mental health and pharmacy services worth an estimated $65.5 million.  In addition 16 doctors were arrested for participating in false billing practices to defraud the government.  The total amount of loss involved in the cases amount to over $260 million dollars.   (see    Whether you were arrested in New York, Miami or in Los Angeles, a person charged with fraud including Medicare fraud should immediately consult with an experienced criminal defense lawyer to discuss the possible defenses you may have to often times a complicated federal and state prosecution.

Medicare/Medicaid and Medical Fraud Charges Under Federal Law

Medical provides millions of California residents health insurance.   In addition, Medicare and Medicaid provide health insurance to millions of people across America.  Government medical programs which provide health care and insurance to Californians and others across the country are funded in part by the federal government and are often abused and/or targeted by persons who make fraudulent claims whether it is a doctor or would be patient.  Most often, healthcare fraud occurs when a medical or healthcare company or individual provider collects or tries to collect reimbursements for medical services from the government that are not legitimate including performing medical procedures that are not warranted and over and or double billing the government.

In terms of federal prosecutions, the United States Criminal Code, The Anti-Kickback Statute, the Social Security Act,  the Physician Self-Referral Law (Stark Law) and The False Claims Act, are used to address Medicare and Medicaid fraud cases.  Violations of these statutes may result in nonpayment of claims, exclusion from the Medicare Program, Civil Monetary Penalties  and criminal penalties.

In the federal criminal context,  18 U.S.C. Section 1347 (“The Criminal Health Care Fraud Statute”) outlaws knowingly and willfully executing, or attempting to execute, a scheme or artifice:

a.       To defraud any health care benefit program; or

b.      To obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care.

The penalties for federal medicare fraud can vary from supervised release (probation), 0 to 6 months in prison to 20 to 30 years in prison per violation depending on the nature of the charges violated, the amount of charges, a person’s criminal history and other factors.  A federal fraud case can be very complicated and it is recommended that when arrested on a federal charge whether it may medicare fraud or another charge, that a person immediately consult with an experienced criminal defense lawyer with knowledge of defending fraud cases.

Definition of Criminal Fraud Under The Laws of California

Similar to medicare fraud cases, persons in California often times find themselves facing fraud charges for trying or allegedly trying to defraud the California Medical healthcare system.

In California there are a number of crimes which fall into the category of theft including but not limited to embezzlement and fraud which would include Medical fraud.  If a person is arrested for grand theft and it is their first offense, often times an experienced criminal defense attorney can work out a successful disposition which may include dismissal.  However, if the fraud involves numerous charges of attempts at over-billing the state of California or related conduct, often times the amounts in question exceed $100,000.00 in claimed theft.

In embezzlement, fraud and theft cases involving the taking of $150,000.00 or more in property or monies, California Penal Code section 12022.6(a)(2) provides for an additional state prison sentence of two years consecutive to the prison term for the actual taking of the monies or property which under California Penal Code section 487(a) is 16 months, 2 years or 3 years in state prison depending on the sentence pronounced by the Judge either after a plea bargain or trial.

Moreover, in cases where is person is arrested and charged with taking over $500,000.00 in money or property, California Penal Code section 186.11 provides for an additional prison term of 2, 3 or up to 5 years consecutive to a person’s sentence for the actual conviction under Penal Code section 487(a).  If a person wants to avoid prison, it is often times essential for an experienced criminal defense attorney to negotiate the dismissal of such enhancements in exchange for pleading to the underlying charge which often times will allow for probation or no prison time.

In addition, often times persons can be exposed to a duel prosecution for federal and state crimes if their conduct involved alleged fraud against Medi-Cal and Medicare.   Facing federal or state fraud charges can be very intimidating but there are avenues to successfully defend such cases which can lead to positive results including dismissal, reduction of charges or a civil compromise.  It is best to consult with a seasoned criminal defense attorney to explore your possible options in fighting a California state or federal fraud case.