Whether you were guilty or innocent, criminal charges for defrauding an insurance company can negatively affect you throughout your lifetime. If you are a physician who has been accused of health insurance fraud, you may lose your license to practice medicine and/or be ordered to serve time in jail. Those facing fraud charges are encouraged to contact us at (888) 250-2865 to speak with one of our skilled OC fraud attorneys for a free case evaluation. With experienced representation, you may be able to avoid losing your license and your freedom.
How the District Attorney Prosecutes Insurance Fraud
If you are facing an indictment from the District Attorney’s office, you are not alone. Numerous doctors throughout Orange County are being charged with defrauding insurance companies. For prosecutors, playing hardball with physicians suspected of health care fraud can be a beneficial career move. Those who are guilty of insurance fraud are perceived as ripping off taxpayers, including low-income and disabled individuals. You can expect for prosecutors to pursue maximum penalties against you and be particularly vigorous if/when they decide to participate in plea bargains.
There are a number of different scenarios that can result in health care fraud charges for California physicians including:
Billing for Non-Existent Services
- This is when a medical professional bills an insurance company for patient services or procedures that were never received.
- Upcoding is a term that is used to describe a situation in which a patient is charged for more expensive services than they received.
- Duplicate claims exist when medical professionals bill a patient for the same service or procedure more than the number of times the patient received the service or procedure.
In order for prosecutors to convict you, they not only have to prove that you were involved in the act of fraud, but that you knew it was fraudulent and you participated in an attempt to defraud. The following is more in-depth information about the prosecution’s burden of proof:
Knowledge of a fraudulent or false claim
- If you accidentally defrauded an insurance company, you cannot be convicted of health care fraud.
Intent to commit fraud
- If you did not specifically intend to commit a fraudulent act, according to law, you are not guilty of health care fraud.
Possible legal defenses to help exonerate defendants are usually based on the above principles. If you and/or your defense attorney are able to establish that you did not commit any type of fraud, did not know you committed any type of fraud, or that you did not intend to defraud an insurance company, you will most likely be able to have your case dismissed or obtain a not guilty verdict.
Penalties for Doctors Who Commit Fraud
In regards to what penalties a medical professional can face for defrauding an insurance company, the maximum penalties are based on the amount defrauded. If the claims in question are $950 or less, then your instance of health care fraud will be charged as a misdemeanor offense. If the claims in question exceed $950, prosecutors may file it as a misdemeanor or a felony offense.
The following are the maximum penalties in California for instances of health care fraud:
- One year in Jail and up to $10,000 in fines
- Possible suspension revocation of medical license
- Up to five years in state prison
- Up to $50,000 in fines or twice the amount of money that was defrauded
Those facing charges for misdemeanor or felony health insurance fraud are encouraged to seek counsel from an experienced criminal defense attorney. Medical professionals may make the mistake of trying to examine case law themselves. This can lead to costly mistakes that can negatively affect your case.
Orange County and Riverside Fraud Defense
If you are facing charges in Riverside or Orange County contact our fraud defense attorneys for a free case evaluation. Addressing your charges at the outset of your case may help to secure your medical license and avoid harsh penalties and fines. Call (888) 250-2865 or fill out our contact form to receive assistance from skilled attorneys with a history of success.