Health Care Fraud

Allegations Of Health Care Fraud

Lead by Robert M. Wilson,  the Firm represents doctors, physicians, HMOs, clinics, dentists, psychologists, chiropractors, physical therapists, durable medical equipment suppliers, and other healthcare providers in cases involving the following kinds of allegations:

  • Upcoding
  • Over billing
  • Unbundling
  • Double billing
  • HIPAA violations
  • Submitting a false invoice
  • Prescription audits
  • Medi-Cal fraud
  • Medicare fraud

The federal government has dedicated funding and additional investigative resources to state and local authorities in an attempt to crack down on healthcare fraud. Due to the confusing and complex nature of healthcare billing, healthcare providers often enter in a wrong code over and over again. As a result, what is in reality an honest mistake can look like a pattern of fraud to an over-zealous investigator. Since most investigators aren’t doctors, they often lack sufficient knowledge of the practical reality of healthcare claims adjudication systems. Given the complexity of the Current Procedural Terminology (CPT) codes and the Healthcare Common Procedure Coding System (HCPCS), investigators aren’t always aware why an office visit might need to be reclassified or billed differently than a previous office visit. We review healthcare records and consult billing experts in order to rebut the government’s case alleging healthcare fraud on the part of our client.

Equally important is avoiding charges of obstruction of justice or perjury. Too often, people who are innocent of any wrongdoing panic when they learn they are being investigated. As a result, they destroy or withhold important records from a grand jury or make false or incomplete statements to investigators or FBI agents. In the end, they may be acquitted on charges of healthcare fraud but convicted on obstruction of justice or perjury or false statement charges. Our attorneys will advise and work with you throughout a state or federal investigation in order to ensure you avoid obstruction of justice charges while avoiding self incrimination in the process.

If You Are Currently Under Investigation

Federal or State grand jury investigations may be launched if you are suspected of perpetrating Medicare or Medi-Cal fraud. You must seek counsel at the earliest sign of an investigation (i.e., grand jury/prosecutor subpoena, FBI or other law enforcement inquiry) so we can attempt to resolve the matter, administratively or civilly, prior to the indictment or criminal charging stage. Our firm is dedicated to finding a solution to the case and minimizing the professional and personal trauma associated with these types of cases.

White Collar Criminal matters, such as Medi-Cal or Medicare fraud accusations, may leave a blemish on your otherwise clean record. Let our firm help you understand the gravity of this situation and determine your options for establishing a line of defense or to correct a misunderstanding by an investigating government agency.

Whether you are a doctor, physician, dentist, chiropractor, podiatrist, physical therapist or other health care professional, The Firm offers high-quality defense of medical fraud charges. Lead by experienced health care fraud attorney Robert M. Wilson, we take pride in our ability to fully examine each and every aspect of your case. We offer thorough representation and construct a strong and ethical defense on your behalf.



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