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July 1, 2020


(Defense Attorneys working for California healthcare Providers under Investigation for False Claims Act Violations within the US)

The federal statute that enforces civil and criminal punishments for medical professionals, and others who engage in fraudulent and dishonest Medicare billing in California; is known as the “False Claims Act”. It is a wide law enforcement statute. Federal agencies such as the Federal Bureau of Investigation (FBI), the Centers for Medicare and Medicaid Services (CMS), the Department of Justice (DOJ), and the Office of Inspector General (OIG) utilize it to get at those alleged of Medicare swindle.

There are usually several penalties one may incur for the False Claims Act violation. These include significantly heavy financial punishments, loss of the right to participate in Medicare, and it can be worst! Leading to imprisonment. Therefore, it will be nice you get a team of expert defense attorneys if you are under False Claims Act investigation in California. An experienced team of defense attorneys can assist in protecting your rights during this challenging period.

Being face with the False Claims Act investigation is not equivalent to being charged with a federal offense. But, it does imply that you could end up facing civil charges and it can be worst; you may face criminal charges. It all depends on whether the investigative team finds tangible evidence to back-up allegations of fraud or not. It is good to note that; National investigators and prosecutors in California are frequently aiming at medical doctors and others alleged of the False Claims Act violation. Of course, the earlier the better, hiring an experienced defense Attorneys to assist in the investigation early enough will help you avoid exposure to potential civil or criminal responsibility.

10 steps you should take when under investigation for False Claims Act 

Know The Actual Allegations Against You: This should be your first step toward protecting yourself when being investigated for the False Claims Act violation. you must try to fully know the allegations leveled against you. As a broad federal statute, the False Claims Act encompasses broad and varied types of Medicare fraud. Therefore, understanding the reasons for your investigation is crucial to staging-up an effective defense. Check out Some of the most common accusations of False Claims Act violations below:

  • Billing for undelivered services or falsifying the ordering or utilization of tools and supplies. This is also known as phantom billing.
  • Billing for inessential medical services, equipment, or supplies
  • Multiple billing, and coding frauds like upcoding
  • Proving medical professional qualifications for medically inessential supplies. A good example is DME
  • Receiving of giving kickbacks
  • Proving medical professional qualifications for medically inessential services. such services like in-home health or hospice car.

Nevertheless, even if you think that you or your services may have violated the False Claims Act, you need not make assumptions or work with baseless claims. You just need to avoid giving any sensitive information to the prosecutors. Again, you must understand that the only way to be sure you violated the False Claims Act or not, is to discuss with an expert healthcare fraud defense attorney.

Know The Implications Of Civil Responsibility Or A Criminal Quilt: The punishment you are to face depends on whether the nature of your False Claims Act investigation is civil or criminal. The following are civil punishments:

  • Damages that worth three times the amounts fraudulently billed to Medicare
  • You may be charged to pay up to $11,000 fines for each false claim
  • Denial of hospital privileges and benefits
  • Loss of future claims payment and denial of the right of participating in Medicare
  • Repayment/replacement requests

The criminal penalties may include:

  • Possibly fines that worth up to hundreds of thousands of dollars
  • Federal imprisonment of about 5 years per charge

Determine Whether the Investigation is Civil or Criminal in Nature: Having the degree of the possible punishments at the back of your mind, when under a False Claims Act investigation, your most crucial task becomes; determining whether you are faced with a civil or criminal investigation. Let’s say the investigation is civil, the best is to maintain it that way. You don’t want it to escalate. On the other hand, let’s say it is a criminal investigation; it becomes mandatory you develop a defense strategy that is centered on preventing the prosecutors from proving the accusations against you.

Act As Fast As You Can And Prevent Mistakes That Could Limit Your Defense Team: Early intervention is the key to the success of all Medicare fraud investigations. Your defense team has to establish contact with the investigators and prosecutors in charge of your case. Again, you must act proactively, ensuring that all the measures needed to protect yourself and your practice are in place. At Spodek Law Group, P.C. we can help with:

  • General Protocols: steps to take (what to Do)
  • Instructions for Management: How best to handle Agents
  • Instructions for Employees
  • Document Retention Forms
  • Compliance Test Instructions
  • Important Contact Information

Contact us today for mind-blowing emergency response!

Seek More Information About Your case: False Claims Act investigation is a stressful, difficult, and distracting experience. Therefore, you need to make efforts to get informed about the process as much as you can. The healthcare fraud defense attorneys and former federal prosecutors at the Spodek Law Group, P.C. have explained what medical practitioners in California are required to know when under a federal investigation: below are the 5 articles:

  • Investigations Explained
  • How Federal Criminal Cases Work
  • What to Do First When Charged with a Federal Crime
  • Charged with a Federal Crime? What You Need to Know
  • What to Do if you Need a Criminal Defense Attorney

Try To Know About The Possible Defenses To Federal False Claims Act Violation: With the bifocal decades of experience in False Claims Act investigations including accusations of Medicare fraud, the lawyers at Spodek Law Group, P.C. have established several successful defense strategies for defending clients in both civil and criminal liability. When you utilize our firm as your defense, we will carry out a critical examination of your case to come up with the best strategies. Our goal and effort will be directed to making sure no civil or criminal liability is obtained against you, if possible.

Below are possible defenses to accused violations of the False Claims Act:

  • Lack of Evidence: it is the responsibility of the government to give evidence of your civil responsibility or criminal conviction beyond a reasonable doubt. If we can debunk the prosecutors’ evidence (or prove the lack of evidence), we can effectively prevent your investigation from resulting in charges.
  • Lack of Criminal Intent: The prosecutors must be able to prove the existence of your indispensable criminal intent. Our team of defense attorneys is an expert in utilizing various strategies for arguing that. Therefore, in a situation whereby you submitted a false claim, you will not be charged with liability, since there is a lack of criminal intent.
  • Statutory Medicare Fraud Defenses

From safe refuge to special cases for particular sets of situations, various statutory defenses are employed to protect medical practitioners from liability under the False Claims Act. Our decades of bifocal experience in False Claims Act investigations, have helped our attorneys to become experts in sorting the array of defense strategies that will benefit you.

Know That Criminal Defense, Healthcare Law, And Healthcare Fraud Defense Attorneys Are Not Same: under False Claims Act investigation, you have to know the type of attorney to involve for your defense. You shouldn’t engage a criminal defense attorney, who may be an expert in general defense strategies but a novice in healthcare-specific issues. It will be wrong to engage a healthcare lawyer, who is knowledgeable about the essential principles of law but is inexperienced in argument presentation during investigations, plea negotiations, and trial. Here is the right thing to do When Facing a False Claims Act investigation; engage legal a team of experienced healthcare fraud defense attorneys. These lawyers are not just skilled in criminal law and healthcare law, but also good in how to present effective defenses rooted upon the application of particular healthcare law notions within the field of a federal investigation.

Know The Relevance Of Hiring Former Federal Prosecutors For Your Defense: including former federal prosecutors is a wise move to protect yourself. This is because they understand your situation from the government’s perspective. They will be aware when the government decides to start investigations, and why prosecutors will decide to withhold charges due to the defense strategies presented.

Get Ready For Your First Consultation: The first step in the intervention of a law firm is the initial consultation. During this period, you will want to know everything about the firm as much as possible. Therefore, bellow are possible questions:

  • What is the level of experience of the attorneys in False Claims Act investigations?
  • Are they former healthcare fraud prosecutors?
  • How familiar are the attorneys with the Medicare billing process and possible causes of common billing errors?
  • How much success have you achieved in preventing civil or criminal charges in related cases?
  • How fast can your attorneys make contact with the investigating team handling my situation?
  • What are my expectations in the coming weeks, considering the nature of the government’s investigation?

You will be required to submit a subpoena and any other relevant documents.

Make Sure You Engage A Reputable Law Firm With A Relatable Success Stories In False Claims Act Investigations: Having a defense team with a proven success record in False Claims Act investigations would be helpful. At Spodek Law Group, P.C., we have helped several clients in their cases which lead to no civil or criminal charges.




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