Healthcare fraud allegations can be devastating, threatening professional licenses, careers, and personal freedom. At Simmons & Wagner, we firmly believe in the fundamental principle of innocence until proven guilty, and we leverage our unique experience as former Orange County District Attorneys to provide robust defense strategies to clients facing healthcare fraud charges.
What is Healthcare Fraud?
Healthcare fraud involves deceptive practices aimed at unlawfully benefiting financially from healthcare systems, insurance providers, or government programs like Medicare and Medicaid. Common forms of healthcare fraud include:
- Billing Fraud: Submitting false claims for services not provided or inflating charges.
- Kickbacks: Receiving illegal compensation in exchange for referrals or prescribing certain medications or treatments.
- Prescription Fraud: Prescribing unnecessary medications or falsifying prescriptions.
- Upcoding: Billing for a more expensive service than the one actually provided.
- Unbundling: Charging separately for procedures that should be billed together.
Innocent Until Proven Guilty: Why It Matters
Being accused of healthcare fraud does not automatically imply guilt. The legal principle of “innocent until proven guilty” ensures that prosecutors bear the full burden of proving allegations beyond a reasonable doubt. This standard is crucial because healthcare practices and billing are inherently complex and often subject to honest errors or misunderstandings rather than deliberate fraud.
At Simmons & Wagner, we emphasize protecting this fundamental right, ensuring our clients receive fair treatment and the chance to fully present their defense.
Simmons & Wagner’s Experience Makes a Difference
Our attorneys’ prior roles as Orange County District Attorneys provide distinct advantages in healthcare fraud defense:
- Insider Knowledge: We thoroughly understand prosecutorial methods and priorities, enabling proactive, effective defense strategies.
- Strategic Defense Planning: Our experience allows us to predict and counter prosecution tactics, enhancing the likelihood of favorable outcomes.
- Skilled Negotiation: Leveraging our prosecutorial backgrounds, we effectively negotiate plea agreements, reduced charges, or case dismissals.
Common Defense Strategies in Healthcare Fraud Cases
Simmons & Wagner employ several key defense strategies tailored to healthcare fraud cases:
1. Lack of Intent:
Proving that billing errors or discrepancies resulted from inadvertent mistakes or administrative oversights rather than deliberate intent to defraud.
2. Challenging the Evidence:
Meticulously reviewing billing records, patient files, and financial transactions to identify inaccuracies, inconsistencies, or misinterpretations by investigators.
3. Compliance with Industry Standards:
Demonstrating adherence to established healthcare industry practices and regulations, showing that the accused actions were legitimate and compliant.
4. Entrapment or Procedural Violations:
Identifying instances where investigators may have violated legal procedures or engaged in improper entrapment tactics, potentially invalidating key evidence.
5. Expert Testimony:
Utilizing healthcare experts to explain complex medical procedures, billing practices, and regulatory compliance, clarifying misunderstandings, and countering allegations effectively.
Defending Your Reputation and Career
Accusations of healthcare fraud can severely damage reputations and threaten professional credentials. Simmons & Wagner prioritize not only legal victories but also minimizing collateral damage to our clients’ reputations and careers. Our proactive approach ensures thorough preparation, clear communication, and aggressive defense aimed at achieving the best possible outcome.
Call Simmons & Wagner Today
Facing healthcare fraud charges is challenging, but an accusation is not a conviction. At Simmons & Wagner, our experience as former Orange County District Attorneys positions us uniquely to defend clients effectively against healthcare fraud allegations. We passionately advocate for our clients’ rights, employing comprehensive strategies to ensure justice, fairness, and protection of their professional futures. Call (949) 439-5857 for a free consultation!