What Are the Penalties for Healthcare Fraud in California?

Let's Get Started
On Your Case

What Are the Penalties for Healthcare Fraud in California?

medical instruments in a doctor's office

As a doctor or healthcare professional, you take great pride in your ability to treat patients and help treat their ailments and illnesses. However, if poor judgment or a technological error causes you to face fraud claims, you may not know how to proceed. Unfortunately, your license could be on the line. If accused of healthcare fraud, you’ll need the assistance of an experienced Sacramento criminal defense lawyer to assist you through this complex process.

What Is Healthcare Fraud?

Healthcare fraud is a form of insurance scam in which medical professionals, treatment centers, and other medical institutions take advantage of the often complex billing system used by facilities and insurance centers. These schemes often go unnoticed by patients, as they may not be able to discern expected costs from fraudulent ones.

There are a few ways in which insurance scams can occur. The most common are submitting billing claims to an insurance company for services a patient never received. To make this less noticeable, many providers will “upcode” or charge for a similar but more expensive service.

Also, it’s not uncommon for doctors to falsify records to make a medically unnecessary test seem essential for a patient. Finally, if you accept kickbacks from another doctor or facility for referring patients to them, you can face charges of healthcare fraud.

What Penalties Can I Face if Charged With This Offense?

If charged with any form of healthcare fraud in California, it’s vital to understand that you can face severe consequences. To determine the severity of the crime, a monetary value is often used to delineate between a felony and a misdemeanor conviction.

For claims involving less than $950, you’ll likely face a misdemeanor. This includes the potential for up to six months in jail and a $1,000 fine. However, fraud involving more than $950 can be treated as a “wobbler.” Essentially, the aggravating circumstances of the case will determine whether it should be charged as a felony or a misdemeanor. If charged with a felony, you can face up to five years in jail, probation, and heft fines including $50,000 or double the amount you were charged for frauding.

It’s also important to note that those convicted of healthcare fraud may face a suspension or revocation of their medical license.

What Possible Defenses Can I Use?

When facing a healthcare fraud charge, understanding what potential defenses you can use is vital to protect yourself and your medical license. Most commonly, the best defenses for these circumstances involve proving that the billing issue was an error caused by staff or technology or that you genuinely believed the patient required the services you provided and billed for.

The most important thing to remember is that you should not face these charges alone. At the Law Offices of Dale R. Gomes, we understand that insurance is complex. As such, we will do everything possible to help you through this difficult time.