Los Angeles Medicare Fraud Lawyer
Charged with Medicare Fraud in Los Angeles? Federal Prosecutors Have Already Been Building Their Case.
Medicare fraud charges are federal. They are investigated by the Department of Justice, the FBI, and the HHS Office of Inspector General and the investigations behind them run for months or years before a single arrest is made. By the time federal agents contact you they have typically already reviewed your billing records, interviewed your staff, and built a detailed financial picture of your practice or business. If you are under investigation or have been charged with Medicare fraud in California do not speak to investigators without an attorney present. At The Law Offices of Arash Hashemi our Medicare fraud lawyer in Los Angeles has spent over 20 years defending clients against federal healthcare fraud charges. Call (310) 448-1529 or contact our office today for a free confidential consultation.
Medicare Fraud in California — What Prosecutors Are Actually Charging
Medicare fraud in California is prosecuted under 18 U.S.C. 1347 which covers any knowing and willful attempt to execute a scheme to defraud a federal healthcare program. The statute is written broadly and federal prosecutors apply it to a wide range of conduct in the healthcare industry. Common charges include:
- Billing for services never rendered: submitting claims to Medicare for appointments, procedures, or supplies that were never actually provided to the patient
- Upcoding: billing for a higher level of service or more expensive procedure than what was actually performed
- Unbundling: billing separately for services that should be billed together at a lower combined rate to inflate reimbursements
- Double billing: submitting duplicate claims for the same service or supply to collect payment more than once
- Billing for unnecessary services: ordering or billing for procedures, tests, or equipment that was not medically necessary
- Kickback arrangements: paying or receiving compensation for patient referrals in violation of the Anti-Kickback Statute (42 U.S.C. 1320a-7b)
- Phantom employees: listing non-existent staff members on billing records to inflate costs
- Waiving co-payments as part of a billing scheme to increase the volume of Medicare reimbursements
These charges are not limited to physicians. Medicare fraud charges in California are regularly filed against medical billing companies, healthcare administrators, nurses, pharmacists, durable medical equipment suppliers, and home health agencies. Anyone who submits, supervises, or benefits from fraudulent Medicare billing can be named in a federal investigation.
Medicare Fraud Penalties and Consequences in California
The Medicare fraud penalty under 18 U.S.C. 1347 is up to 10 years in federal prison per count. When the fraud resulted in serious bodily injury the penalty increases to 20 years and when it resulted in death it carries a potential life sentence. Federal prosecutors stack counts freely meaning a practice that submitted fraudulent claims over an extended period can face dozens of counts with combined sentencing exposure reaching decades.
Beyond prison time the Medicare fraud consequences in California extend to every area of a defendant’s professional and financial life:
- Fines up to $250,000 per count for individuals
- Mandatory restitution to Medicare for the full amount of all fraudulent claims
- Asset forfeiture of all proceeds traceable to the fraud including bank accounts, equipment, and real estate
- Mandatory exclusion from Medicare, Medicaid, and all federal healthcare programs upon conviction — permanently ending the ability to practice in most healthcare settings
- Loss of medical, pharmacy, nursing, or other professional licenses
- Permanent federal felony record affecting employment, housing, and immigration status
- Civil liability under the False Claims Act which allows the government to recover triple damages plus penalties of $13,000 to $27,000 per false claim
The Medicare fraud consequences in California are compounded by the fact that federal healthcare fraud investigations almost always result in immediate asset freezes and civil parallel proceedings running alongside the criminal case. Having a Medicare fraud lawyer in Los Angeles who handles both the criminal defense and coordinates with civil counsel is critical from the very first day.
Medicare Fraud Penalties and Consequences in California
The Medicare fraud penalty under 18 U.S.C. 1347 is up to 10 years in federal prison per count. When the fraud resulted in serious bodily injury the penalty increases to 20 years and when it resulted in death it carries a potential life sentence. Federal prosecutors stack counts freely meaning a practice that submitted fraudulent claims over an extended period can face dozens of counts with combined sentencing exposure reaching decades.
Beyond prison time the Medicare fraud consequences in California extend to every area of a defendant’s professional and financial life:
- Fines up to $250,000 per count for individuals
- Mandatory restitution to Medicare for the full amount of all fraudulent claims
- Asset forfeiture of all proceeds traceable to the fraud including bank accounts, equipment, and real estate
- Mandatory exclusion from Medicare, Medicaid, and all federal healthcare programs upon conviction — permanently ending the ability to practice in most healthcare settings
- Loss of medical, pharmacy, nursing, or other professional licenses
- Permanent federal felony record affecting employment, housing, and immigration status
- Civil liability under the False Claims Act which allows the government to recover triple damages plus penalties of $13,000 to $27,000 per false claim
The Medicare fraud consequences in California are compounded by the fact that federal healthcare fraud investigations almost always result in immediate asset freezes and civil parallel proceedings running alongside the criminal case. Having a Medicare fraud lawyer in Los Angeles who handles both the criminal defense and coordinates with civil counsel is critical from the very first day.
How Our Los Angeles Medicare Fraud Lawyer Defends Your Case
Medicare fraud cases live and die on billing records, claims data, and documentation. Every defense begins with a complete independent review of the billing practices at issue before the government’s characterization of them becomes the accepted narrative.
Lack of Intent — The Core Defense
Federal Medicare fraud requires proof of knowing and willful conduct. Billing errors, coding mistakes, reliance on billing staff, and misunderstandings of complex Medicare reimbursement rules are not fraud. Many healthcare providers and administrators charged with Medicare fraud had no idea the billing practices at issue were improper. Our firm builds the lack of intent defense through your training records, your compliance policies, the advice of billing professionals you relied on, and documentation showing the absence of any fraudulent purpose.
Challenging the Government’s Billing Analysis
Federal investigators use statistical sampling and extrapolation to project fraud losses across thousands of claims from a limited sample. These methodologies are frequently flawed and overstate the actual loss by millions of dollars. Our firm works with independent healthcare billing experts to scrutinize the government’s analysis, identify errors in the sample, and present a more accurate picture of the actual billing practices that directly challenges the prosecution’s loss calculation.
Medical Necessity Defense
When the government alleges that services were medically unnecessary our firm works with independent medical experts to review the patient records and establish that the diagnosis, the treatment ordered, and the billing code used were all clinically appropriate for the patient’s condition. When independent expert review supports the medical necessity of the services at issue this directly dismantles one of the prosecution’s central theories.
Suppression and Constitutional Challenges
Medicare fraud investigations involve extensive searches of medical records, billing systems, financial accounts, and electronic communications. When that evidence was obtained through unlawful searches, overbroad warrants, or without proper legal process our firm files suppression motions immediately. Excluding key billing data or financial records from a Medicare fraud prosecution can fundamentally alter what the government is able to prove.
Contact a Medicare Fraud Lawyer in Los Angeles Today
If you are under investigation or have been charged with Medicare fraud in Los Angeles do not speak to federal investigators and do not wait. The earlier a Medicare fraud lawyer in Los Angeles is working on your case the more options you have to challenge the evidence, protect your assets, and prevent the most severe Medicare fraud consequences from taking hold.
Contact our office today for a free confidential consultation. Attorney Hashemi will review the charges, analyze the billing records at issue, and begin building your defense from day one.
Schedule a free Consultation:
- Phone: (310) 448-1529
- Email: Info@hashemilaw.com
- Address: 11845 W Olympic Blvd #520, Los Angeles, CA 90064
- Office Hours: Monday to Friday, 8:30 AM – 5:00 PM, with flexible scheduling options available, including weekend appointments.
We are conveniently located in the Westside Towers serving clients facing Medicare fraud and federal healthcare fraud charges across Los Angeles, Beverly Hills, Santa Monica, the San Fernando Valley, Long Beach, and all surrounding communities. Your defense starts the moment you call.