Medi-Cal Fraud Attorneys
Our firm has been handling cases involving Medi-Cal fraud for years. We have represented doctors, pharmacists, manufacturers and other healthcare professionals facing a wide variety of fraud charges.
Medi-Cal fraud is a serious crime and penalties can extend to decades in prison. Additional consequences, including permanent exclusion from Medi-Cal and loss of one’s medical license, can be professionally devastating.
If you are facing Medi-Cal fraud charges, you need the representation of a well qualified criminal defense firm behind you. Our criminal attorneys have the knowledge and experience necessary to ensure you do not spend the rest of your life suffering the consequences of a mistake.
Please get in touch with us for a risk-free consultation today. Our counsel is 100% confidential and geared toward helping you sort through your options with the understanding you need to make a well-informed decision. Whether you are under investigation or simply concerned about potential liability, we are fully available to assist you.
What is Medi-Cal Fraud?
Medi-Cal is a need-based health benefits program offering both free and reduced-cost health coverage to those with limited resources. Qualifying for this program depends on a number of factors including income, residence, age, and health condition.
Medi-Cal fraud can occur in a number of ways. Patients can commit Medi-Cal fraud by lying about eligibility criteria. However, the most aggressively prosecuted forms of Medi-Cal fraud are generally committed by healthcare providers. Below are just a few examples:
- Billing Medi-Cal for services you actually provided but were unnecessary.
- Billing Medi-Cal for services you never performed.
- Billing Medi-Cal for services that were more expensive than the ones you actually performed.
- Receiving or paying kickbacks in exchange for Medi-Cal billing referrals.
Medi-Cal fraud steals billions of tax dollars from California and its residents every year. Because the demand for Medi-Cal services is higher than the available funding, Medi-Cal fraud prevents countless Californians from receiving the healthcare they desperately need.
In addition, Medi-Cal fraud puts patients at risk by exposing them to profit-motivated services they do not actually need. This wastes resources by diverting time, money, and attention away from the goal. The main focus should be diagnosing and treating the conditions that bring patients into doctors’ offices, but instead, it turns to greed.
Because fraud complicates the purpose of Medi-Cal, to provide life-preserving care to those in need, efforts to stop it are aggressive. Both state and federal goals are more focused on effective detection and prosecution of healthcare fraud. This makes the likelihood of escaping liability less promising than it has ever been.
What Charges Could I Face If I Commit Medi-Cal Fraud?
If you have committed Medi-Cal Fraud, you may be charged under both federal and state law. Even though Medi-Cal is a state program, federal statutes including the False Claims Act, False Statements Act, Social Security Act, and general Healthcare Fraud statute can be violated.
These statutes make it a crime to submit false claims for reimbursement to benefit programs like Medi-Cal. This means that your charges can be brought under federal law.
Often, Medi-Cal fraud is violated with other crimes including conspiracy, money laundering, obstruction of justice, and financial fraud. Whether you are tried in federal or state court, sentencing can range from probation and fines to decades in prison.
It is also likely you will be unable to participate in the Medi-Cal program. This could be permanently or for a set length of time. Depending on the severity of the conduct, the permanent loss of one’s medical license might occur.
Generally, penalties depend on the amount of money falsely received:
- The length of the fraudulent scheme.
- The degree of fraudulent intent evidenced by the conduct.
- The plan and how many people are involved in the scheme.
A criminal defense attorney works these confusing and subjective factors in your favor so, at worst, you walk away with a far less severe penalty than you would have otherwise received.
However, to reach a conviction under any statute requires proof of each element beyond a reasonable doubt. Your criminal defense attorney may be able to succeed in earning you a not guilty verdict. They may also even get your case dismissed before trial, in which case no punishment can legally be imposed.
Our firm has succeeded in such favorable outcomes for our clients time and again. We have the knowledge and experience necessary to produce the best results possible in your situation.
Our clients have ranged from those wrongly accused, to those who were caught red-handed. Regardless of your situation, our approach is grounded in hard work, brilliant strategy and a thorough understanding of the laws. Let us put our skills to work for you.
What Do Medi-Cal Fraud Cases Look Like?
Cases of Medi-Cal fraud are often brought under federal law because the federal government wants to eliminate healthcare fraud. Below are a few examples of the types of charges and penalties providers have faced.
In 2013, Kim Ricks, the owner of a durable medical equipment supply company, pleaded guilty to a healthcare fraud scheme which defrauded Medicare and Medi-Cal of nearly $700,000. Ricks was charged on one count of conspiracy to commit healthcare fraud. He admitted to knowingly violating Medicare and Medi-Cal rules and regulations by submitting claims for durable medical equipment such as power wheelchairs on behalf of people with no medical need for such equipment.
In addition, Ricks fraudulently obtained the identifying information of patients in order to bill for equipment they never received. He admitted to committing the fraud in order to keep his company viable.
In 2015, another medical supply company owner, Sylvia Walter-Eze, was convicted of one count of conspiracy to commit health care fraud, four counts of health care fraud, and one count of conspiracy to pay and receive illegal kickbacks. Similar to Ricks, Walter-Eze paid kickbacks to physicians who wrote prescriptions for expensive and medically unnecessary power wheelchairs.
The scheme resulted in over $3 million dollars of fraudulently billed Medicare and Medi-Cal payments.
In 2016, Priscilla Villabroza was charged with Medi-Cal fraud after she took part in a $9 million dollar Hospice fraud scheme. In addition to illegally paying marketers in exchange for referrals, Villabroza had nurses and doctors lie and falsify documents that said patients were terminally ill and entitled to hospice benefits.
As a result, non-terminally ill patients were told they were dying and transferred to hospice care, where they received treatment to ease the death process, rather than extend their life.
When Medicare audited Villabroza, she attempted to cover up the scheme by altering records so that patients appeared to be sicker than they actually were to receive benefits.
Villabroza had illegally purchased the hospice center while under investigation for a prior scheme, for which she was sentenced to 4.5 years in federal prison. In addition to the prior conviction, Villabroza was sentenced to 9 years in federal prison and ordered to pay $7.5 million dollars in restitution.
Also in 2016, a Long Beach substance abuse treatment provider was charged with Medi-Cal fraud after submitting over $50 million dollars in false claims. The treatments were either not provided at all or were provided to teens that did not actually have a substance abuse problem. This violated Medi-Cals eligibility requirements.
In addition to the financial cost of the scheme, this fraud harmed teens by unfairly labeling them as substance abusers. It also wasted resources by limiting actual substance abusers the help they needed.
If convicted, the defendants face maximum sentences ranging between 32 and 194 years in federal prison.
In 2018, two executives at an LA treatment center were charged with defrauding Medi-Cal, after they allegedly billed for $2 million dollars in both ineligible and unprovided services over a 6 year period.
Mesbel Mohamoud and Erlinda Abella were indicted on 21 counts of healthcare fraud and 2 counts of aggravated identity theft. While their center had contracted to provide medically necessary substance abuse treatment services, they submitted false bills for services which were either not conducted at all, or which failed to comply with Medi-Cal eligibility requirements.
Although the case is ongoing, the two providers could each face a minimum sentence of two years in federal prison for the aggravated identity theft charges, as well as a maximum of 10 years for each of the 21 counts of healthcare fraud.
What Should I Do If I Am Being Investigated For Fraud?
These cases show that sentencing for Medi-Cal fraud can range significantly. Certainly, the strength of the prosecution’s evidence combined with the severity of the conduct are conditions which, at a certain point, become out of your control. However, the same facts and evidence can give rise to a range of jail time spanning decades.
If the prosecution has concrete evidence that you knowingly put a patient’s health at risk, you will likely receive a penalty. But your defense team and the lawyers at our office can help minimize the penalty you receive. The right criminal lawyer can save years you would otherwise have spent behind bars.
Our criminal attorneys know how to turn a bad situation around. Even if your conduct is less severe than the cases above described, our attorneys could take the possibility of jail time off the table for you. We also try to limit the negative impact on your professional and personal life.
Call us today for a risk-free consultation, so that we can help you understand every detail of your situation before making any decisions. We look forward to assisting you.