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If you’re a Los Angeles- or Southern California-based physician, pain management specialist, pharmacist, nurse, or chiropractor, and you receive a grand jury subpoena or are contacted by a federal agent for a healthcare fraud investigation, your whole career is at stake.
You could be facing more than just hundreds of thousands of dollars in fines and decades of prison time. You also could lose your license. Your business and personal property could be in forfeiture.
Everything you’ve worked so hard for could be swept away.
This situation has become all too common in Southern California. Considering the diversity and density of populations in and around Los Angeles, the region is fertile ground for federal healthcare fraud prosecutions. It has one of the highest rates of federal healthcare fraud indictments in the country — so much so that, since 2010, the U.S. Department of Justice (DOJ) has operated a “strike force” to prosecute healthcare fraud in and around L.A.
Healthcare fraud — including Medicare fraud, Medicaid fraud, and TriCare fraud — has been the main target of federal prosecutors in recent years. That focus has led prosecutors to charge weaker cases, while hoping that overwhelmed defendants and inexperienced attorneys will fail to see those weaknesses.
Only a Los Angeles healthcare fraud defense attorney who has focused his/her practice on this complex, ever-changing area of law is qualified to provide the best representation in a healthcare fraud case.
That’s why so many Los Angeles healthcare providers have the criminal healthcare lawyers from Chapman Law Group on their side.
Because we have honed our expertise in defending providers against healthcare fraud charges by obtaining pretrial dismissals, not-guilty verdicts, and beneficial plea agreements in federal courts across the U.S.
We have a unique depth of knowledge of the investigating agencies, their methods of operations, and their weaknesses. We have the tools needed to get the best results for providers accused of Medicare, Medicaid, TriCare, and insurance carrier fraud.
We know what it takes to win even the most complex healthcare fraud case — because healthcare law is all we do.
As part of our service to you, even before you contact us, we want to help make sense of what healthcare fraud is all about, how investigations take place, and the paths cases can go.
Healthcare fraud is simply making a false claim to a healthcare benefit program. To prove that a defendant committed healthcare fraud, the government must show that he/she made a false claim to a healthcare benefit program such as Medicare, Medicaid, TriCare, and insurance carriers such as Blue Cross Blue Shield. The breadth of that definition allows the government to charge any person that it believes it can prove:
The government must prove this beyond a reasonable doubt.
Our specialist attorneys regularly come across general criminal defense attorneys who do not know — to the detriment of their clients —that violations of billing requirements such as local coverage determinations (LCDs) or national coverage determinations (NCDs) do not satisfy this requirement, without evidence of other conduct.
But a Los Angeles health care fraud defense attorney from Chapman Law Group knows that government and the DOJ Healthcare Fraud Strike Force regularly investigate and bring charges against providers for what are essentially differences of opinion over:
In essence, the government must prove that you intentionally created and used a scheme to lie to a healthcare benefit program in order to gain a benefit. Oftentimes, the job of an experienced healthcare fraud attorney is to make clear that these differences of opinion do not fit that definition.
Most federal healthcare fraud investigations begin through audits, whistleblower tips (also known as Qui Tam matters), or patient complaints.
Virtually everyone is familiar with the FBI, but few are aware of the Department of Health and Human Services’ Office of the Inspector General (HHS-OIG). The OIG is the nation’s leading law enforcement agency for investigating healthcare fraud. Its focus is to protect beneficiaries and federal healthcare programs such as Medicare, Medicaid, and TriCare. More times than not, the OIG is leading the healthcare fraud investigation, working directly with the prosecutors from the U.S. Attorney’s Office.
When it comes to auditing, the Centers for Medicare & Medicaid Services (CMS) and HHS review statistical data generated from Medicare and Medicaid bills to look for outliers. Once the OIG or CMS finds an outlier, it typically conducts an audit and, in severe cases, may immediately refer a case for criminal prosecution.
During an audit, HHS will obtain billing records and request medical records. An initial audit may require review of only a few files, often called a probe audit.
If fraud is suspected after an audit, the case will be referred for investigation and prosecution. When the case is referred, federal law enforcement agents will begin investigating the billing data and interviewing witnesses in order to prepare a case.
Once the case is prepared, an attorney from a local U.S. Attorney’s Office or the Healthcare Fraud Strike Force will prepare an indictment and take a case to a grand jury. If the grand jury returns an indictment, the subject of that indictment will be charged with healthcare fraud and will be required to defend that indictment in court.
Healthcare fraud is predominately prosecuted by the federal government and the DOJ Healthcare Fraud Strike Force. The following laws are utilized by the federal government to prosecute healthcare fraud:
A typical healthcare fraud indictment will charge one overarching count of conspiracy to commit healthcare fraud, along with several “substantive” counts alleging individual executions of the scheme. Money laundering charges and forfeiture charges also commonly appear in these indictments.
The conspiracy charge is one of the government’s favorite prosecutorial tools in healthcare fraud cases, as it only requires that the government prove an agreement to commit healthcare fraud and an act in furtherance of the scheme.
The Government will also seek to seize significant assets from a healthcare fraud defendant, in an effort to keep the defendant from being able to marshal the funds to mount a successful defense.
Hopefully, if you are reading this, you are doing so because you suspect that charges may be brought against you. If so, you have an opportunity to have an aggressive advocate right from the beginning, because you are in what is known as the pre-indictment investigation stage.
At this point, the government’s agents are doing everything they can to get evidence they believe will suffice to convince a grand jury to charge you with fraud and related offenses. Many people suspected of fraud offenses miss the important opportunity available during this stage, to obtain the services of a lawyer who can conduct his/her own investigation, engage in negotiations with the government, and even convince the government not to pursue charges.
If you are being charged in federal court with healthcare fraud — whether involving Medicare, Medicaid, TriCare, or other — you will likely already have heard the term “indictment.” The indictment is the document that the prosecuting agency — generally, the local U.S. Attorney’s Office— uses to tell you and the U.S. District Court the criminal charges that are being brought against you.
The indictment is created secretly by a grand jury, then kept sealed until the U.S. Attorney decides to arrest and process everyone who is charged in the indictment. In general, the indictment will name doctors, office staff, pharmacists, DME providers and others involved in the care of patients and the provision of medication, goods, and other services.
If you are unable to avail yourself of the assistance of an attorney before the indictment is unsealed, or if the government nevertheless decides to proceed with charges, and the grand jury issues an indictment, the government will unseal the indictment and you will be brought to court. From this point, the case will proceed with an often-dizzying speed.
That’s why it’s crucial to have an attorney who is not only an effective advocate for you, but who also understands the importance of helping you understand and be prepared for the proceedings, right from the start.
Even at the indictment stage, the importance of a reputable, established attorney is paramount. That’s because the unsealing of the indictment is the last step before a defendant is either arrested by agents of the federal law enforcement agency that conducted the investigation (often the DOJ’s multi-departmental Health Care Fraud Strike Force, or the HHS’s Medicare Fraud Strike Force), or is told by an attorney that the suspect has already retained, and who has already contacted the investigating agency, that he or she needs to “walk in” to be arraigned in court.
You will need a seasoned Los Angeles health care fraud defense attorney — one who whose aggressive, thoughtful advocacy has already earned the respect of the investigating agencies and prosecutors, one who can make the process easier — right from the beginning.
Immediately after you are arraigned, an office of the court known as Pre-Trial Services will interview you to decide whether, and under what conditions, you can be released on bond.
Arraignment simply means being you are informed of the charges, by a federal magistrate, to determine how you will plead. The judge will then determine whether you can be released on bond.
Only an experienced Los Angeles healthcare criminal defense attorney will understand the importance of this decision, as outcomes for defendants released on bond — who have the breathing room to review their options with their attorneys — are consistently better than for those forced to make life-altering decisions while in pre-trial custody.
Likewise, only a reputable healthcare fraud attorney accompanying you through the pre-trial services interview will be able to give you the best chance of release on the least-restrictive bond conditions. At Chapman Law Group, our healthcare criminal law attorneys have succeeded at getting our clients “bonded out” more than 95% of the time.
After bond is decided, the case enters what is known as the discovery phase, during which you and your attorney begin to be provided with some of the evidence the government intends to use to prove that you committed the charges in the indictment.
However, the Federal Rules of Criminal Procedure, which lay out many of the procedures and obligations of each party in a criminal case, do not require the government to provide all of the information in its possession — at least not at this stage.
Nor, obviously, does the government know everything about your case, which is why, during this time, your counsel also conducts an investigation. Just as the government’s disclosures may continue throughout the proceeding, so will our search for any material we can use to mount the best possible defense. (We believe that the best defense is a good offense, and we hope that, even if you choose another attorney, you will be wary of anyone who does not engage in his/her own investigation.)
While the discovery is ongoing, and as we review the information we are provided, we will file any of a number of pretrial motions. A variety of motions exist for a variety of purposes. Among those motions, some ask the court to require the government to provide additional discovery, or to prevent it from using certain evidence, or even to dismiss the case.
At Chapman Law Group, our Los Angeles healthcare fraud defense attorneys are experienced “law and motions” practitioners, and we know how to use these documents for substantive and tactical purposes.
Good pretrial motions practice, as well as good discovery practice, have an important purpose apart from their direct ones: each can be used as a powerful tool in your attorney’s plea negotiations.
Even assuming you didn’t commit the alleged offense, a good healthcare fraud attorney will continuously engage the government in negotiations to get you a “deal.” Such negotiations can help your attorney learn more about the government’s case against you and the tactics it plans to use at trial. They can even help convince the government to amend the indictment and allow you to plead guilty to some lesser charge.
Eventually, your case will be set for a pre-trial/plea cutoff hearing. This is the last pre-trial hearing before the jury trial begins, and it is the date at which the judge finds out whether you wish to plead guilty pursuant to a plea agreement between you and the government (a “Rule 11”), or whether you wish to “put the Government to its burden” by demanding your constitutional right to a jury trial.
If you indicate that you do intend to go to trial, your lawyer, the judge and the prosecutor will use this hearing to discuss how and when the trial will take place.
Once your trial date comes, you can expect your trial to last anywhere from a week to several months. Healthcare fraud trials can have such varying lengths because of the variation in complexity and number of co-defendants in different cases.
If a jury finds you guilty beyond a reasonable doubt on at least one charge, or if you plead guilty, either by way of a plea agreement, or an “open plea” directly to the court, you will be given a date for a sentencing hearing.
This hearing allows the judge to review information about you and your case, which has been collected by Pre-Trial Services and presented in a Pre-Sentence Investigation Report (PSR). This report typically includes information the pre-trial officer gets during an interview with you, at which your attorney should be present, and for which he or she should have prepared you.
The consequences of a healthcare fraud felony conviction can last longer than just a term of incarceration, so it is important to weigh all your options before accepting any plea deal or deciding to go to trial. A plea to accept a felony charge for healthcare fraud or Medicare fraud should not be based solely on the potential jail time
At Chapman Law Group, our attorneys understand the magnitude of these ramifications on a healthcare professional’s career and work to minimize the fallout.
In addition to a possible prison term (many healthcare fraud crimes carry a potential maximum 10- or 20-year prison sentence), a conviction may result in:
A healthcare professional under indictment, or being investigated, should be under no illusion: by the time the government has obtained an indictment, its investigating agency will have completed a thorough investigation.
The first truth about defending such a case? The earlier a suspect gets a reputable, experienced attorney to intervene, the better that suspect’s result is likely to be.
Pre-indictment intervention, including a probing investigation by the attorney’s trusted investigators, along with the creation of a compliance plan, may remedy the issue before the courts become involved.
Even after an indictment is issued, an attorney’s immediate, focused efforts will result in much more favorable outcomes. Your attorney must quickly analyze the discovery provided by the government, as well as insurance claims, patient records and witness statements.
At Chapman Law Group, we seek at the outset to obtain a dismissal for any client, so our attorneys prioritize a review of the medicine to craft an argument that the claim was properly, or at least, not fraudulently billed. To do so, we engage the services of a certified biller and a health professional of the same profession.
If we conclude that such an argument is not tenable, we next attempt to craft a defense that the amount of the fraud showed on billing materials (called the loss amount) was so low that it is not evidence of a scheme.
Our Los Angeles health care fraud defense lawyers have the experience to engage in a multi-pronged defense, seeking the best results for our clients, by as many means as are available.
Federal sentences are created using the Federal Sentencing Guidelines, which are a framework of rules used by judges to calculate the range of sentences for federal crimes. If someone is convicted of healthcare fraud, the sentence is almost exclusively determined by the fraud loss amount to the entity billed — generally the value of claims billed.
The Affordable Care Act, contains a provision that puts healthcare fraud defendants at a distinct disadvantage at sentencing, by considering the amount of claims billed to a healthcare program prima facie evidence of the loss amount — in essence, making the defendant responsible for disproving that the billed amounts accurately represent what the healthcare program actually lost.
Only experienced Los Angeles healthcare fraud defense attorneys like those at Chapman Law Group know what healthcare provider knows: that Medicare, Medicaid, and private insurers usually pay some amount less than the amount billed. By using that, and other strategies, our attorneys regularly shrink the loss amount presented as fact by the government, and thereby significantly lessen the potential prison terms facing our clients.
We know not to allow the court to accept numbers the government has inflated by using poor methodology. And a well-skilled healthcare fraud defense attorney — the kind you will find at Chapman Law Group — will know other strategies useful for determining a lower loss amount, such as claim sampling and extrapolation.
We also know the importance of differentiating you from the dozens of other healthcare fraud clients a federal district court judge is likely to see in any year. That’s why we use our response to the presentence investigation report, our sentencing position paper, not just to craft legal arguments, but also to paint a picture of our clients as individuals.
Because at Chapman Law Group, we never forget that we as attorneys are experienced and comfortable maneuvering the criminal justice system — but you as a client are not. And you aren’t simply a case number to us.
Facing something as career-threatening as healthcare fraud means your whole world is hanging in the balance.
You need to have a Los Angeles health care fraud defense lawyer you can fully trust. You need the confidence to know that he/she is fighting for you and looking out for your best interests.
You need to be certain that your lawyer can take a case to trial and is not looking to just plead you guilty. Your lawyer must be reachable when you have questions.
At Chapman Law Group, we aggressively protect clients’ rights every step of the way. Our lawyers strive to always keep clients informed, explain the process, and answer any and all questions.
Our Los Angeles health care fraud defense attorneys have been battling these federal Medicare fraud strike forces for several years, so our healthcare clients get the kind of Medicare fraud defense no one else can offer.
We have keen insight into the feds’ and the strike force’s tactics. We can detect their weaknesses. And we know how to get results for our clients facing healthcare fraud indictments. Our Los Angeles healthcare fraud defense attorneys have a reputation in winning many cases by dismissal or not-guilty verdicts at trial.
We also know that fighting a case through trial places a heavy burden — emotionally and financially — on a family. And one of the critical differences between the Chapman Law Group and other criminal law firms is our focus on preventing an arrest and charges from being filed.
We actively investigate allegations and start building a defense for our clients before the case ever goes to court.
Many times, we can convince the government not to file charges, contending that our client committed no crime. In other instances, we are able to resolve a case through a diversion agreement, which results in a case dismissal. And in some situations, we can settle a case through a civil agreement and payment of a fine.
Even in situations where criminal charges are filed, we are often able to get a result that would substantially reduce the potential jail time and other penalties.
And, moving forward, we can help you develop a stronger, more effective compliance program for your practice, so as to avoid accusations of healthcare fraud and be prepared if the government decides to conduct an audit.
When you have government investigators staring you down and accusing you of healthcare fraud, Chapman Law Group is the law firm for you.
For 35 years, our healthcare lawyers have aggressively defended licensed healthcare professionals on criminal matters — from the internal investigation right up through trial.
We have honed our expertise in defending providers against healthcare fraud charges by obtaining pretrial dismissals, not-guilty verdicts, and beneficial plea agreements in federal courts across the U.S.
Our dedicated Los Angeles healthcare fraud defense lawyers are led by a former federal prosecutor and staffed with attorneys who exclusively defend healthcare fraud cases — many of whom have advanced degrees in healthcare law.
We are solely dedicated to representing licensed healthcare providers — including physicians, pain management specialists, pharmacists, and psychologists — in criminal law matters such as healthcare fraud.
Besides having a proven track record of winning healthcare fraud cases by dismissal or not-guilty verdicts at trial, our knowledge, training, and experience ensure that we are able to do so more quickly — and with less expense — than other criminal defense lawyers.
Very few law firms in the U.S., if any, can make these claims and back them up with our results.
Our clients include practitioners in cities, counties, and communities all across Los Angeles and Southern California — Pasadena, Long Beach, Santa Monica, San Fernando Valley, San Bernardino, Anaheim, Irvine, Huntington Beach, Newport Beach, as well as Los Angeles County, Orange County, Ventura County, San Bernardino County, and Riverside County.
Contact us today to learn more about what an experienced, reputable Los Angeles health care fraud defense attorney can do for you, and how we are ready to help you with the best healthcare fraud defense.
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