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The cases of fraud by medical professionals are on the rise. The laws dealing with abuse and fraud are complicated making it necessary for medical practitioners to understand them. Violations of these laws could lead to civil fines, criminal penalties, loss of one’s medical license, exclusion from health care programs among many other consequences. The five basic federal abuse and fraud laws applicable to medical practitioners are the Anti-Kickback Statute, the Stark Law, the False Claims Act, The Civil Monetary Penalties Law, and the Exclusion Statute. Various government agencies are involved with enforcing these laws including the Centers for Medicare and Medicaid Services, The Department of Health and Human Services Office of Inspector General, and the Department of Justice.
This statute is a law that prohibits willfully and knowingly paying remuneration to reward or induce patient referrals or doing business with services or items payable by federal health care programs. The penalties under this statute include huge fines, exclusion from participating in federal health programs, and jail term. If you’re facing allegations, then we recommend you speak to our Los Angeles Medicare Fraud attorneys.
The Stark Law is also called the Physician Self Referral Law. This law prohibits medical practitioners from recommending patients to receive health services that are payable by Medicaid or Medicare from entities with which the medical practitioner or their immediate next of kin has a monetary relationship. Proof of intent to violate this statute is not required. The penalties under this law include fines and exclusion from participating in federal health programs. Our Los Angeles medicare fraud law firm can help you fight any allegations that are incorrect.
False Claims Act
This statute is against medical practitioners who overcharge or charge the government for unnecessary medical procedures. This statute operates together with other abuse and fraud laws. If a claim is made for a kickback or violates the Stark Law, it could be regarded as fraudulent or false and result in liability under the False Claims Act as well as the kickback or Stark Law.
Civil Monetary Penalties Law
The civil monetary penalties could arise from various behaviors and leads to different levels of assessments and penalties depending on the violation at hand. Penalties amount from $10,000 – $50,000 for a violation. These penalties can be negotiated, or dismissed, if you have a Los Angeles Medicare Fraud lawyer on your side.
The Human Services Office of Inspector General is authorized to exclude entities and individuals from federal health care programs such as Medicaid and Medicare. Individuals can be excluded based on reasons belonging to any of two categories: mandatory or permissive. Excluded persons are banned from furnishing all kinds of services including management and administrative services.
Medicare Fraud Examples
Medicare Statute of Limitations
The Federal Statute 18 USC 3282 protects a person from being prosecuted for any non-capital crime if he/she is not indicted within five years. In most cases, crimes that fail to meet this guideline cannot be prosecuted. However, the consequences of being charged with Medicare fraud are still severe even if one is not prosecuted. The reputation of the medical practitioner or the organization he/she works for will be ruined.