At MacGregor & Collins, LLP, we provide every alleged criminal offender in California with a free case evaluation. Over the last few months, we have noticed an increase in inquiries pertaining to health care fraud, also known as insurance fraud, by physicians and other medical professionals. Prosecutors seem to have set their targets on physicians throughout Southern California.
 
Regardless of whether or not there is enough evidence to convict a doctor of committing fraud, the allegations alone can affect employment. Those indicted for health care or insurance fraud are in danger of losing their license to practice medicine and may benefit from obtaining a free consultation from one of our experienced legal professionals.
 

Why Doctors are Being Charged

 
There are numerous reasons that doctors could be charged with defrauding insurance companies. In my experience, doctors are charged for making mistakes more often than for willfully committing fraud. If a doctor and/or their attorney is able to establish that the alleged charges are the result of an accident, the defendant may be able to have their charges dropped and their case dismissed.
 
The following are common reasons that physicians are charged with committing fraudulent offenses:
 
Multiple Claims for the Same Service
  • If a medical professional intentionally charges a patient multiple times for a service that was only provided once, they may face charges arising from duplicate claims. Insurance companies are becoming especially vigilant to cut down on costs. Doctors who intentionally or mistakenly create duplicate claims may have to explain themselves in a court of law.
Charging for the Wrong Codes
  • Known in some circles as “upcoding”, charging a patient for services that are more expensive than the service that they received can result in criminal charges. Again, it is not uncommon for doctors to mistakenly commit this act, but if there are multiple instances of these mistakes committed by the same physician, courts will be less likely to forgive and forget.
Charges for Services that Were Never Performed
  • These violations are rarely committed by accident, but it is not impossible. If a doctor charges the wrong patient for services received by another patient, the paperwork confusion could lead to California fraud charges.

How to Avoid a Conviction

 
There is no sure-fire way to avoid a conviction for health care fraud; each doctor’s defense strategy and potential for a case dismissal must be assessed on a case-by-case basis. There is no secret formula that will allow defendants to keep their medical license and avoid jail time, but there is hope. An experienced insurance fraud attorney will be able to analyze all of the details and determine flaws in the prosecution’s case. Doctors obtain their positions through a lifetime of commitment and dedication towards their patients and their craft. Facts that support a physician’s contribution to the local and national community are significant, and should be a foundation for any defense involving a medical professional.
 
To secure a conviction for doctor insurance fraud, prosecutors will need to establish that the defendant was aware that they made a false or fraudulent claim and that they did so with the intent to commit fraud. Many of those who are accused of committing these types of offenses were involved in situations that “blurred the lines” of ethical and unethical behavior. In my experience, juries and the general public want to believe that medical professional are not guilty of these types of crimes. With a solid defense strategy and skilled representation, doctors have been able to clear themselves of any wrongdoing and move on with their lives.
 

OC MD Health Care Fraud Defense

 
Medical professionals charged with defrauding insurance companies of any kind are invited to contact our law offices for a free case evaluation. The evaluation is free and there is no obligation to retain the services of the attorney that provides it. Call 949-250-6097 to speak with a legal professional about your case that can help you better understand your charges as well as your available options.