Are Crypto Scams Legal?
It’s challenging to not get sucked into the cryptocurrency craze. Seemingly regular people get lucky and become rich overnight. Bitcoin pretty much became a household name out of nowhere. As more people get involved, it’s easy to see where others might try to take advantage.
Scams are growing more commonplace, even to the point of legitimate transactions getting investigated. If you find yourself under suspicion of this cybercrime, don’t hesitate to contact a cryptocurrency lawyer in California to help you mount a defense.
In the first two months of 2018 alone, a whopping $1.38 Billion was recorded as stolen by cryptocurrency scammers, of which 30% was fraud-related and 13% was due to phishing. It’s no longer contained to just people actively mining, trading and using cryptocurrency, involvement has already extended to the general public.
A quick Google search shows thousands of news reports related to cryptocurrency. And here are just some of the most common cryptocurrency cybercrime scams we’ve come across:
Most Common Cryptocurrency Scams and How they Work
- Imposter Websites – With all the excitement surrounding new cryptocurrency, it’s very easy to accidentally visit a fake website in search of crypto-riches. They are led to think they’ve purchased the next hot crypto-coin, but in reality, they’ve just handed over their payment information to scammers.
- Counterfeit Mobile Applications – These apps are readily available through the Google Play and Apple App Store and go to great lengths to copy the name, appearance and feel of original apps. Their goal is to gain access to your personal information, including login information to cryptocurrency accounts.
- Email Spam – A professional-looking email mixed with a scarcity tactic can cause many users to fall right into the scammer’s trap. They build hype and create some legitimacy for false coins and once the non-existent company seems like a typical business, they hit you with an opportunity to invest.
- Imposter Accounts on Social Media<span< a=””> style=”font-weight: 400;”> – It works by getting people to think that they’re following the social media account of someone they look up to and trust. The account then makes recommendations on which cryptocurrencies will be the next Bitcoin, provides links, and encourages followers to buy specific coins. These accounts may even outright solicit followers to donate or lend cryptocurrencies.</span<>
And while you might not use cryptocurrency, it is gaining widespread traction and the people around you might already be involved in its use. All of the cases mentioned above involve the very easy task of co-opting the identity of a legitimate entity in order to fool an unsuspecting target.
Heightened Security Measures
The reason scams are easily perpetrated in the cryptocurrency world is because cryptocurrency is a decentralized virtual currency. No central banks or third parties are involved in fund transfers so it is practically impossible to trace.
Because of the relative ease of these scams and the growing number of victims, there has been a heightened alert on individuals dealing with cryptocurrency – even legitimate transactions are immediately suspect by the mere fact that cryptocurrency was involved in some way, shape or form, no matter how small.
Grasping at Straws
Imagine this: John is an unsuspecting victim of a scam involving the SCAMCOIN currency. There is no one to trace who the funds went to, but it just so happens that Adam, a legitimate active crypto-trader, bought some SCAMCOINS himself sometime. Adam stands to be involved in the scam.
This means that ANYONE involved with cryptocurrency can potentially be charged with crimes like:
- Cryptocurrency Money Laundering
- Cryptocurrency Fraud
- Fraudulent Initial Coin Offerings (ICO’s)
- Cryptocurrency Theft
Plus several more. And lest you think virtual crimes equate to virtual punishments: the federal government takes a very aggressive stance on cryptocurrency fraud, some sentences may even involve up to 20 years prison time.
Protecting Yourself
But it doesn’t stop there. Since arrows in the scam point to the potential suspect, they might find themselves in the position of needing to settle criminal liabilities, providing restitution, and fighting to restore their lost reputation.
Know this, though: Scams in any industry are not a new thing. Cryptocurrency being a decentralized and open source concept is one of the easiest to replicate and make appear genuine, but not overall impossible to defend. It will be tough, but contacting a cryptocurrency attorney in California to help mount a defense immediately helps to work towards getting it nipped in the bud.
They say that the only guarantees in life are death and taxes. Most people do not look forward to either. And while death is a one-time event, tax season comes every spring. Filing your taxes can be complicated, confusing, and rushed. If you’re being accused of tax fraud, you need to take the situation seriously and secure a Los Angeles criminal defense attorney straight away.
It’s common that those who are under investigation for tax evasion haven’t done anything wrong, but may have misunderstood one of many complex tax rules and regulations. A California tax fraud attorney will work hard to help you avoid the worst-case scenario.
Here’s what you need to know if you find yourself charged with tax evasion in Los Angeles, California:
What Exactly is Tax Evasion?
Tax evasion is most simply defined as a failure to file a federal income tax return or a lapse in the payment of federal taxes. The reality is that the term “tax evasion” can be used to describe several different crimes. Individuals and businesses can be charged with tax evasion. The U.S. Attorney prosecutes five different charges related to taxes:
- Tax evasion
- Filing a false tax return
- Failure to file a tax return
- Conspiracy to file fraudulent tax returns
- Money laundering
Tax evasion is not the same as owing money on your federal taxes. Just because you made a mistake on your taxes and potentially owe more than you thought does not necessarily mean you are guilty of tax evasion. The federal government and Internal Revenue Service (IRS) have to prove that you purposefully left out more income than you claimed. They also look for patterns of not reporting a percentage of income over multiple years.
Tax evasion is also different from tax fraud, although they are both serious matters. Tax fraud is when people provide incorrect information on their taxes to overstate their expenses or downplay their income. Tax fraud is often part of tax evasion, but tax evasion has the elements of trying to avoid filing and paying taxes over simply providing incorrect information.
Common Types of Tax Evasion
It might feel like the IRS is just waiting for someone to make a mistake so they can pounce with an investigation and lawsuit, but the reality is that the IRS wants to give taxpayers the benefit of the doubt and assume most errors are simple mistakes. These mistakes will need to be rectified and there might be penalties, sure, but those kinds of outcomes are drastically different from being convicted of tax evasion.
The IRS identifies common forms of tax evasion. If they see one or more of these and observe a pattern, that could raise red flags and lead to an investigation. Here are the most common forms of tax evasion in Los Angeles:
- Failing to report cash income
- Reporting less than your actual income
- Hiding money in overseas accounts
- Improperly claiming a tax deduction
- Omitting property
- Underreporting an estate’s value
- Over reporting the value of property donated to charity
- Paying employees in cash (under the table) and not filing the proper returns
What are the Punishments for Tax Evasion in California?
The penalties for tax evasion are among some of the harshest for non-violent crimes. The IRS can issue monetary fines, recommend time in jail – or a combination of both. Since tax evasion is a federal crime, it comes with stringent penalties.
Depending on how severe your alleged tax evasion is, you could face up to $250,000 in penalties. If it’s your company’s taxes in the hot seat, that amount could double. The nature of your case could also result in up to five years in prison. On top of fines and prison time, you may also be responsible for all court costs along with any money that you still owe the IRS.
Strict punishments like these are all the more reason that you don’t want to try and defend against these accusations on your own. Making a mistake in court or during the investigation will cost you a great deal of money or your freedom. Sometimes both. A federal criminal defense attorney will be able to help you create a strong defense and potentially even avoid a case in court.
A Good Defense Wins
Investigations into tax evasion are lengthy and expensive. Federal agents of the IRS Criminal Investigation Division are methodical in their work. These investigations can take months or years to complete and when enough evidence is found, you could be charged with and placed on trial for tax evasion. The trial is prosecuted by the United State’s Attorney’s Office and/or the U.S. Department of Justice’s Tax Division.
A proactive defense includes presenting evidence to the U.S. Attorney or U.S. DOJ attorneys to prevent actual prosecution. In many instances, your federal criminal defense attorney may be able to get the prosecutors to accept the payment owned with penalties without going to court. This is often the best-case scenario short of having charges completely dropped.
In case you are charged and convicted of tax evasion, your tax evasion lawyer can help get a reduced sentence, lower fines, etc.
The first thing you want to do when charged with tax evasion in Los Angeles is to contact a California criminal defense attorney. They will guide you through the next steps and make sure you’re not blindsided by the process.
While you’re working on setting up a consultation and meeting with a tax evasion lawyer, do your best to gather all pertinent information for the taxes in question. This information includes anything that shows your income for the year, like a W-2 or 1099-MISC, as well as any receipts and expenses.
And be completely honest with your defense attorney to ensure they can actually help you. Armed with accurate and complete information, your lawyer and any of their experts on retention should be able to pore through and find enough to show that you simply made a mistake.
Without professional assistance, you’ll be navigating a complex system. That small mistake you made could turn into a significant issue. The best way to protect yourself and/or your business is to hire legal counsel. Even if you suspect that you might be investigated in the future due to normal but potentially suspicious activity, like foreign bank accounts, make sure to contact a tax evasion attorney sooner than later. You’ll be glad that you did.
The term cybercrime refers to any criminal activity that takes place online. If you are accused, under investigation for, or are arrested for a crime in cyberspace, you’ll need a cybercrime lawyer on your side. Many cybercrimes go against both state and federal laws and can carry a hefty fine plus time in prison.
Instead of taking the risk of going it alone or hiring a general law practitioner, stick with attorneys who have a proven track record in the realm of cybercrimes. You’ll be glad that you did.
Most Common Types Of Cybercrime
Fraud
While the term fraud is relatively general, it applies to a number of cybercrimes. Fraud is an act that intends to deceive someone else to gain valuable information or data. Altering, destroying, stealing, or suppressing information to obtain an unfair or illegal gain is fraud.
Hacking
Hacking is accessing a computer or private information on a computer without the owner’s permission. Hackers also seek to access specific functions of networks, systems, and websites.
While most of these attacks are against corporate and government accounts, they can be committed against personal computers or networks. Technically, even logging in under someone else’s account without their knowledge or permission is considered hacking and is punishable by law.
Identity Theft
Instances of identity theft are certainly on the rise. Criminals steal personal information and essentially pretend to be someone else. Identity theft includes stealing data like passwords, bank account information, credit or debit cards, social security numbers, and more. These thieves then use this information for their own purposes.
Scamming
With the popularity of the Internet, scamming has taken on new levels. Scammers often offer products or services that don’t exist or don’t get the job done. In some cases, scammers provide services to solve problems that don’t even exist. Some of the most popular scams involve offering computer repair, network troubleshooting, IT services, and more.
Computer Viruses
Most computer viruses give criminals unauthorized access to computers, systems, and networks. Other viruses are meant to actually destroy computers and systems. Most computers are infected via removable devices like flash drives and the Internet.
Downloading or opening an unknown or unsafe file can install a virus without the user being aware that it happened. Once a virus is installed, the criminal can steal data or even hold private information for ransom.
Spamming
We often think of unsolicited bulk messages as spam. Spam is just like the junk mail we get in our physical mailboxes in our e-mail boxes instead. Spamming is annoying and can lead to legal action, but isn’t necessarily a cybercrime. However, spam that is used to deceive, host fake website links, or commit other acts of fraud falls under the cybercrime umbrella.
Phishing
Phishing is when criminals try to obtain someone’s personal information like passwords, credit or debit card numbers, etc. Phishing attempts are often sent through email containing fake links or even appearing like legit businesses. Users who aren’t careful could give away sensitive information without realizing it.
Copyright Infringement
There are tons of websites and programs that allow users to download and install unauthorized copies of software, music, movies, books, and more. Downloading these illegal copies is akin to shoplifting from a store.
People use computers to access and steal more than media files. In some cases, people copy or steal product designs, business plans, and blueprints. Any time someone violates intellectual property laws, they commit copyright laws.
Child Pornography
Any visual depiction of sexually explicit conduct involving a minor is considered child pornography. The Internet makes obtaining and distributing child pornography easy, and even though both federal and state lawmakers have cracked down on instances of child pornography, it remains rampant.
Cryptocurrency Fraud
Virtual currencies like Bitcoin are all the rage these days. The Internet advances and moves so quickly that policymakers have a hard time keeping up. Some even compare cyberspace to the Wild West; so many people are trying to jump in on the virtual gold rush that it’s easy to fall into a scam. Because companies like Bitcoin are so new, cryptocurrency lawyers must work hard to keep up with new technology and policies.
Electronic Harassment
Often called cyberstalking or cyberbullying, electronic harassment is when someone uses the Internet to annoy, abuse, threaten, or harass another person. Electronic harassment most often takes place via social media but can happen in email, chat rooms, and more.
The Punishment for Cyber Crimes
Most cyber crimes involve multiple crimes carried out in concert. Hacking, for example, might include acts of fraud, phishing, computer viruses, and more. Hacking, under 18 U.S.C. Section 1030, is a federal crime and is punishable by up to ten years in prison and $250,000 in fines. Child pornography, on the other hand, can fall under U.S. Code 18 Section 2252(a)(4)(b) and can include up to 40 years in prison.
Some cybercrimes are so complex and new that there aren’t specific laws or legal codes to define their punishments yet. In these cases, courts look at the severity of the act and other instances of crimes involved. Cryptocurrency fraud, for example, is often tried as grand theft, computer fraud, hacking, phishing, and so on.
Call Our Cyber Crime Attorneys Today
Whether you’ve been accused of a cybercrime or you’re a victim of one, you’ll need the best help in California. The LibertyBell Law team of experienced and professional cybercrime attorneys is ready to help your case. Don’t delay and give us a call today.
California is known for being the cultural hub of the world. The west coast’s most significant state is also the technology capital of the world. Silicon Valley is home to companies like Google, Apple, and Facebook. Coincidentally, California can also call itself the cybercrime capital of the U.S.
If you or someone you know has been charged with or is being investigated for committing a cybercrime, you’ll want to work with an experienced cybercrime lawyer. Most computer crimes in California are considered felonies. Computer crimes are serious issues, so this is not the time to try and go it alone.
Most Common Types Of Cybercrimes In California
Hacking
Hacking is defined as accessing a computer or personal data on a computer without the owner’s permission. Several companies like Target, British Airways, and T-Mobile were all hacked in the last couple of years. In these cases, hackers accessed millions of customers’ credit and debit cards, personal data, and more.
Under 18 U.S.C. Section 1030, hacking is a federal crime. Hacking as a misdemeanor could incur a prison sentence for up to one year and face a $100,000 fine. A felony conviction can result in ten years in prison and up to $250,000 in fines.
Phishing
Phishing is an attempt to obtain someone’s personal information: login name, passwords, credit card details, and more. Phishing attempts often look legitimate. The most well-known scam of this type is the old Nigerian Prince email that is meant to get your personal banking information.
Modern phishing attempts often include sending a virus or a link to malware. When someone clicks on the link, the hacker gains access to the victim’s computer. Due to the sheer number of ways people attempt to get personal data from others, phishing is by far the largest cybercrime in the state.
There aren’t any specific laws that deal directly with phishing. There are, however, various other crimes that come into play when information is obtained: credit card fraud, identity theft, or HIPAA violations, to name a few.
Identity Theft
For more than a decade, identity theft has been the number one complaint to the Federal Trade Commission. It’s estimated that over 10,000 people have their identities stolen in the Los Angeles area alone.
California places identity theft under PC 530.5. If, however, someone steals another person’s identity using the internet, it’s now a federal crime under 18 U.S.C. Section 1028. A conviction for identity theft could result in up to 15 years in prison and $250,000 in fines.
Tax Refund Fraud
The most common instance of tax refund fraud is when someone uses the social security of a deceased person to file a tax return. This scam usually involves phishing for information or purchasing info from the black market.
Tax refund fraud falls under 26 U.S.C. Section 7206. The punishment is up to three years in prison and $250,000 in fines.
Theft of Sensitive Data or Intellectual Property
The Computer Fraud and Abuse Act protects information like customer or employee information, trade secrets, source codes, and other pieces of data stored by a business. It is considered theft of sensitive data when someone copies information, often on a flash drive, with the intent to sell it or use it to compete.
Intellectual property, on the other hand, involves copyrighted material like movies, music, and book. It can also include blueprints or designs for company products. Under 18 U.S.C. Section 2319, stealing intellectual property could result in ten years in prison and up to $2,500 in fines. Taking sensitive data, however, falls under 18 U.S.C. Section 1030.
The punishment varies depending on the situation, but possible jail time and penalties can be pretty hefty.
Electronic Harassment
When someone uses the Internet to annoy, abuse, threaten or harass another person, it’s considered electronic harassment. The more common term is cyberbullying. This is most often accomplished via social media, but it can take place in a variety of manners.
Under California Penal Code Section 649.9, electronic harassment can be charged as either a misdemeanor or a felony. A misdemeanor is punishable by up to one year in prison. As a felony, this crime could result in up to five years in prison.
Child Pornography
Federal law defines child pornography as any visual depiction of sexually explicit conduct involving a minor. It is illegal to produce, distribute, import, or possess any kind of child pornography.
If someone uses the internet to distribute child pornography, it can become a federal crime. U.S. Code 18 Section 2252(a)(4)(b), the punishment could include up to 40 years in prison and a fine of $250,000.
Cryptocurrency Crime
With the popularity of cryptocurrencies like bitcoin, it’s no wonder that crimes involving these virtual coins are increasing. Some estimates suggest more than a billion dollars of virtual currencies are stolen each year through hacks, scams, and fraud.
When cyber thieves are caught, they are typically prosecuted under laws for grand theft, computer crimes, hacking, phishing, and more. Because there are often multiple layers in use to steal cryptocurrencies, punishments vary and are often stacked.
Call Our Cyber Crime Attorneys Today
If you’ve been accused of a cybercrime, you need the best representation in the area. Our experience defending cyber crimes is unparalleled. From hacking to bitcoin lawyers, LibertyBell Law Group is able to handle anything that crosses our path.
The potential punishment for cybercrime convictions is severe. Instead of taking the chance of going to prison, paying huge fines, or having a crime on your record, let us help you. From getting cases dismissed to creating opportunities for beneficial plea bargains, we can give you the best shot at your best outcome. Call today.
In the state of California, people convicted of certain sex crimes must register as a sex offender. Sex offender registries are public and can negatively impact one’s ability to get along in a new neighborhood. If you are accused of a sex crime in California, it’s crucial that you speak with a Los Angeles criminal defense lawyer. These sex offender attorneys understand the legal landscape and can make sure you get a fair trial.
Here is what you need to know about California’s laws regarding sex crimes.
Sex Crime Laws in California
Sex Offender Registration Duties in California
In the past, anyone convicted of certain sex crimes in California had to register on the sex offender registration for life.
Registering for the sex offender list is just another way of saying offenders must keep local law enforcement agencies informed of where you live, work, or attend school. Being on the list also means other people can know that you are on the sex offender list, but won’t know the circumstances of your situation.
The recent passing of SB 384, however, puts different requirements on registrants. Most people convicted of sex crimes must register for a minimum of ten or twenty years. Those convicted of serious sex crimes will register for life. How long you register depends on which of the three tiers you are placed.
Tier One: 10-Year Minimum Registration
Crimes that typically land on tier one include misdemeanors such as indecent exposure, arranging to meet with a minor for lewd purposes, sexual battery as a misdemeanor, inducing sex by fraud, and more.
Tier Two: 20-year Minimum Registration
Crimes that land on the second tier include mid-level sex crimes, such as incest, rape, penetrating a victim with a foreign object against their will, and more.
Tier Three: Lifetime On The Registration
Crimes that require a lifetime on the sex offender’s list often include serious sex crimes, like sex trafficking, sex acts against a child, most cases of rape, most cases of sexual battery, and more.
There isn’t necessarily an official, comprehensive list of crimes that make each tier. A judge can order an offender to register on the sex offender registry for any offense if the judge believes they comitted the crime for for sexual gratification.
It’s also important to note that offenders are not automatically removed from the registry at the end of their ten or twenty years. Offenders must petition the court.
California Megan’s Law
In 1996, California passed Penal Code 290.46, also known as Megan’s Law. This law requires the California Department of Justice to alert the public about specified registered sex offenders.
Megan’s law also allows law enforcement agencies to notify the public about anyone on the sex offender’s list, which is considered a risk to public safety.
Megan’s law is named after Megan Kanka, a seven-year-old who was raped and killed. The perpetrator was a known child molester who moved nearby without the family’s knowledge. The Kankas pushed to allow local communities to know about sex offenders in their areas.
Their hope is that by knowing there is a risk, other families can avoid the tragedy they faced. Most states have laws similar to Megan’s Law in order to help alleviate risk.
Megan’s Law and The Sex Offender Registry
After an offender reports a local law enforcement agency of their details, the agency forwards that information to the Department of Justice (DOJ). This information is available via the DOJ’s Megan’s Law website.
If your information appears online, it will often include your name, photo, information about your person (height, weight, tattoos, scars, etc.), and the offenses that subjected you to register.
How to Petition for Removal from California Sex Registry?
Whether an offender can be removed and the exact process of getting off of the Sex Offender Registration list depends on why they were convicted. There are some crimes, like sexual abuse of a child, that make an offender ineligible to be removed from the registry.
Outside of ineligible situations, there are several ways to clear your sex offender status.
Expungement
One of the most common ways sex offenders work to get off of the registry is to complete probation and then apply to have the case dismissed. The rules and regulations for this process are part of Penal Code 1203.4.
While successfully having your case dismissed might take your conviction off of your criminal record, it still may require that you register as a California sex offender.
Certificate of Rehabilitation
Another option for removing your sex offender status is to apply for a California certificate of rehabilitation. This option typically does not require still registering as a sex offender. There are several requirements:
- You can apply seven to ten years after your release from custody or probation
- The court expunged your case
- You haven’t been placed in jail since your case was dismissed
- You are not on probation for any other felony
- You can provide proof that you’ve lived in California for at least five years before applying
Governor’s Pardon
If a convicted sex offender can get a pardon from the Governor, they will be removed from the sex offender registry. A Governor’s pardon, except in infrequent circumstances, requires at least two years of a crime-free life after you’re released from custody or probation. There is no guarantee that the Governor will issue a pardon, but it is another option.
Failure To Register
If an offender fail to register, they hurt their chances of finding relief from their sentence. A judge will most likely issue a California Bench Warrant or Arrest Warrant due to the violation.
Failure to register or to keep law enforcement appraised to changes in residence, etc., is a violation of probation. This could result in jail time and would hurt any chances of applying to be removed from the sex offender registry in the future.
You Are Not Alone
If you or someone you know are arrested for a sex crime, you do not want to face the consequences alone. Having a sex crime defense attorney on your side could be the difference between being put on the sex offender registry and leading an unfettered life.
If you are currently on the sex offender registry and it’s time to petition to be removed, our criminal defense attorneys at LibertyBell Law Group can make sure you have the best chance of success.
Don’t risk the consequences of a sex crime appearing on your record. Find the help you need today.
Healthcare billing fraud costs taxpayers billions of dollars each year. Local, state, and even the federal government are cracking down harder than ever. Even honest mistakes are being investigated and prosecuted, which can put you or your practice through a gauntlet of inquiries, hurt your reputation, and cost a ton in legal fees. While you’ll get the most accurate information about your unique situation from your Los Angeles federal criminal defense attorney, here is what you need to know about healthcare billing fraud:
Healthcare Fraud Defined
When someone in healthcare or Medicare commits a deliberate and dishonest act to benefit themselves or someone not entitled to the benefit, the Center for Medicare and Medicaid Services (CMS) calls it healthcare fraud. In simple terms, if someone knowingly and willfully dishonestly uses a healthcare benefit, it’s considered healthcare fraud. The most common place for this fraud to happen is in the billing process.
Here are some of the most common examples:
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Upcoding
Upcoding is the most common form of healthcare billing fraud. This is when medical providers bill for a more complex procedure than what was performed. Upcoding can quickly happen by accident, but can also be used as a way to meet office goals or hit bonus targets.
An example of upcoding could be if a patient has a short consultation with a nurse or medical assistant. This consultation is less expensive than a more extended examination by a doctor. The provider could charge the patient for the more extended, more expensive visit with a doctor. Since the patient’s copy doesn’t change, they may never know that their visit was upcoded.
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Unbundling
Unbundling is when components of a bundled package are billed separately. More often than not, breaking up the bundle results in a higher price. Unbundling is also easy to happen by mistake, especially if the billing staff isn’t aware that a particular procedure has bundled components.
For example, someone getting a hip replacement might be charged for the surgeon, support staff, and the operating room separately when the procedure should have one all-inclusive fee.
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Coding the Kitchen Sink
When physicians throw in billing codes outside of a confirmed diagnosis, it’s known as coding the kitchen sink. If this is done on purpose, its goal is often to make it appear that the doctor is treating more issues during a single visit. This practice could set up an inaccurate story of the patient’s health. The paper trail could show false, pre-existing conditions that could be detrimental in the future.
Imagine a scenario where a patient comes in for a cough and runny nose. The actual, confirmed diagnosis could be for a viral infection. The doctor could also add that the patient described lower back pain that required a secondary exam. In the future, the patient gets into an accident at work that results in lower back troubles. The insurance company could look back at medical records showing complaints of this pain long before the accident and award no benefits.
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Inconsistent Coding
When a patient’s diagnosis changes without a change in symptoms, it’s considered a consistency error. These errors are most common with procedures or surgery and the physician’s billing codes don’t line up with the bill from the surgery center.
An example of inconsistent coding could be a patient who sees their primary care physician regarding a skin tag. The physician assigns the patient a simple removal procedure from another department in the clinic. If the physician charges for a more expensive cancer screening, but the other department charges for a skin tag removal, it could indicate some miscommunication or fraud.
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Kickbacks
Kickbacks or bribes in healthcare happen when companies pay or otherwise provide gifts to doctors in return for referring patients to them, whether the patient actually needs the treatment/diagnostic test or not.
A very common example of this is when doctors order an expensive diagnostic like an MRI from a very specific provider not because it helps them with their diagnosis, but because the hospital or diagnostic center carrying out the procedure has promised them a referral incentive for doing so.
Even supposing that the patient does need it, the fact that there is an incentive in place for the doctor makes this a prime example of a kickback and is in violation of the 1987 Anti-Kickback Enforcement Act.
To legally fall under the definition of fraud, fraudulent activities must be done knowingly and willingly. That means if the new person in the coding department makes an honest mistake, it won’t ruin your practice. While medical billing professionals should aim for perfection, it’s not uncommon for typos or incorrect billing codes to be used. Innocent mistakes often fall under the category of healthcare abuse, which can be just as dangerous as a fraud in certain circumstances.
Unfortunately, even fraudulent activity made by mistake can still result in an investigation. On that same note, doctors or staff who are unaware of fraudulent activities can still be involved in an investigation and suffer the consequences.
What to do when you see someone Unbundling and Upcoding
Since Fraud can happen on both the patient and the practitioner’s end of care, it’s essential that everyone involved take the right steps to avoid even the appearance of healthcare billing fraud.
For Medical Professionals
- Make sure to document everything. Most Electronic Medical Records (EMRs) and Electronic Health Records (EHRs) have the ability to add notes. Practitioners should keep track of all pertinent details of a patient’s visits: symptoms, complaints, concerns, etc. You’ll also want to document why you are recommending certain medication, medical equipment, referrals, etc.
- Keep Your Staff Up-To-Date. Medical billing is extremely complex, so it’s worthwhile to invest in ongoing training for your staff. Eliminating typos and careless errors will go a long way in protecting your practice.
- Have your team conduct regular audits to identify and correct errors. Use these audits to determine where your staff has the most trouble and create training around those issues. You can also identify employees that are a liability due to their many mistakes.
- Always have a clear policy regarding all things related to billing fraud. Obviously, committing fraud is unacceptable. Make sure your policy points out attractive shortcuts and potential problems in hopes of shutting down fraudulent activities before they happen.
For Patients
- Always keep your insurance information safe. Don’t give out your insurance card, policy numbers, etc. unless it’s absolutely necessary. If someone else gets this information, they may try to receive treatments under your account.
- Make sure you understand why equipment, medication, or medical devices are being prescribed. Don’t accept anything that is unnecessary.
- Check that you only get the medical supplies you ordered. It’s very easy for someone to slip in a little extra while making sure to charge for every item.
You’re Not Alone: Contact a Los Angeles Criminal Defense Attorney Today
The ramifications of medical billing fraud should be scary, but not enough to paralyze your practice. Mistakes happen, and you might find yourself under investigation. But make sure you always have your Los Angeles healthcare lawyer assist in any accusation or investigation regarding healthcare fraud. Even if you’re not under investigation, you’ll want to make sure you’re operating above water and a healthcare attorney will be there to help. Don’t go at it alone when help is closer than you think.
Even being accused of a sex crime can have devastating results. From being misidentified by a victim to being accused by someone with malicious intent, there are countless scenarios where someone may be falsely accused of committing a crime. Even the most experienced Los Angeles criminal defense lawyers have yet to see every possible situation. Learning that you’ve been accused of something so despicable can be traumatic in itself so it’s crucial you know what to do and what not to do. But if you do find yourself in this position, know this: you’re not alone. By working with a sex offender attorney, you have the best chance for the best outcome.
Whether you’ve already been accused of a sex crime or fear that it could happen to you, here is what you need to know:
What to Expect Once You’re Accused of a Sex Crime
One of the best ways to know how to proceed after being accused of committing a sex crime is to understand what the process looks like. Of course, knowing the general process by no means gives you enough information to make complete decisions; your criminal defense lawyer will always be the best resource for advice on how to proceed.
Law Enforcement Gets an Incident Report
If someone believes they’ve been the victim of a sex crime, they have to file a report with the police before anything happens. As an adult, the person with the complaint can decide if they want to actually file a report or not. This decision should be taken seriously and those who have been victims of a sex crime should contact their local police department. Prosecutors will hesitate to pursue a case unless they believe the victim will fully cooperate and even testify in a trial if needed.
Laws regarding sex crimes against minors are stricter. In many cases, if someone hears that a child has possibly been sexually abused, they have no choice but to contact the authorities. People like teachers, doctors, counselors, and more are legally obligated to contact a social service agency or the police if they learn of or believe a sex crime has been committed. Even the victim’s parents do not have the option to not press charges. The decision on whether to press charges or not is entirely up to the prosecuting attorney’s office.
Investigation
After law enforcement receives a complaint about a sex crime, their next job is to investigate and the initial investigation looks for evidence to support the claim. This initial assessment often happens without the alleged perpetrator’s knowledge, unless the victim makes their complaint known. Law enforcement will interview the victim, the parents of the minor victim, and any other witnesses.
At some point, law enforcement will contact the accused. They might stop by your place of residence, leave you a voicemail, or just leave a note at your door. They’ll often downplay the accusations in hopes that you’ll share your side of the story. Police officers are especially good at making you feel like they are on your side or that refusing to talk makes you appear guilty. In many cases, they won’t even tell you what the allegations are until you speak to them.
It’s crucial to note that you do not and should not talk to the police at this time. Even if you are innocent, you could say something that will raise a red flag. Police officers are skilled at getting people to lock themselves into inaccurate statements, go back on their previous words, or even to give a false confession. You have every right to have a sex crime defense lawyer present for every conversation with the police. There is nothing to gain by sharing your side of the story on your own, regardless of how intimidating the police are.
Friends and Family Will Ask
It’s only a matter of time before people in the community learn about the accusations against you. Whether it’s the accuser making their report known or people just hearing things through the grapevine, people will ask you questions. Most of these people just want to listen to your side and believe what you tell them. Unfortunately, you don’t know who you can trust. Mistakenly saying the wrong thing to the wrong person can have horrible consequences. The police might even fake calls to try to get you to hurt yourself by talking.
You Get Arrested and Charged for a Sex Crime
Once law enforcement believes they have enough evidence, they will submit their information to the prosecuting attorney. This office will decide whether or not to issue a warrant. Keep in mind that this process can take months after the initial complaint and investigation. Just because you haven’t heard anything for a while doesn’t mean you’re out of the woods yet.
If you’re wise enough to have contacted your Los Angeles sex crime defense attorney before the arrest happens, the police might contact your lawyer first. This is in hopes that you will surrender yourself. Otherwise, the police will issue a warrant and arrest you on site. As you can imagine, being arrested can be humiliating. You’ll experience fear and confusion about what happens next. At this time, you should absolutely not say anything to the police outside of asking to contact your lawyer. They will advise you about moving forward.
What Should You Do After Being Accused?
From the moment you suspect that you’re going to be accused of a sex crime, you need to take action to protect yourself. It’s easy to believe that you’ll be found innocent since you know you didn’t commit the crime, but prisons are full of people who thought something similar.
The first step is to consult with a sex crimes defense attorney. You can often get a free consultation to discuss your situation and talk about options. This should be the first and only person you talk to about the details of the accusation. You shouldn’t talk to anyone about the situation, especially the accuser. Many attempts to smooth things over or solve a misunderstanding result in making matters worse.
You’ll also want to write down everything you can remember from the incident in question. Create a list of potential witnesses and other encounters with the accuser. Your attorney is the only other person who will see this list, so keep it safe.
Being accused of a sex crime puts you in a severe situation. The good news is that you’re not alone in your fight. Contact an experienced team of sex crime defense lawyers and give yourself the best chance at building a strong defense.
The healthcare industry is one of the most highly regulated industries. Fraud in the healthcare industry ends up costing taxpayers billions of dollars every year. That means both federal and state governments are eager to crack down and eliminate medical fraud at every turn. Organizations even accused of committing healthcare fraud are put through a variety of investigations and tests. Facing these alone without a healthcare fraud lawyer can worsen an already stressful situation.
What NOT to Do During a Healthcare Fraud Investigation
What is Healthcare Fraud?
The Center for Medicare and Medicaid Services (CMS) defines fraud in healthcare or Medicare as “deliberate and dishonest acts committed to benefit the person committing the act or someone not entitled to the benefit.” Health care fraud occurs when a business or someone knowingly and willfully uses a healthcare benefit program dishonestly.
Here are some of the most common examples:
- Misrepresentation of the level or type of services provided.
- Misrepresentation of the individual rendering service.
- Billing for items and services that have not been rendered.
- Billing for items and services that have not been adequately documented.
- Seeking payment or reimbursement for services rendered for procedures that are integral to other procedures performed on the same date of service, often known as unbundling.
- Seeking increased payment or reimbursement for services that are correctly billed at a lower rate, known as upcoding.
- Misusing codes on a claim.
- Charging excessively for services or supplies.
- Billing for services that were not medically necessary.
Most healthcare professionals would never commit an act of fraud on purpose. Committing fraud by accident can still land these professionals in hot water.
For an act to be legally considered as fraud, the person involved must knowingly engage in fraudulent activities. That means a simple mistake doesn’t necessarily mean the action is fraud. A typo that results in a patient being billed for additional treatment isn’t necessarily fraud unless the person makes the error on purpose.
Of course, despite claiming that fraudulent activity was done in error, an investigation may still be carried out. Further, even if you’re unaware that someone in your office is committing fraud, it does not necessarily mean that you will not ultimately be implicated.
Mistakes You Should Avoid During a Healthcare Investigation
If the government decides to investigate you or your office for healthcare fraud, you want to respond appropriately in order to protect yourself. The first step is to hire a healthcare fraud attorney. This will ensure that you have a guide who understands the process and aggressively work to protect your interests.
Here are the most significant three mistakes people make when facing an investigation:
Ignoring the Investigation
Whether there is evidence fraud took place or not, the investigators will approach the process as if you are guilty. Ignoring the investigation will only hurt your case.
You might think that ignoring the investigation will make it go away. Sadly, all this does it make the investigation happen without your input. Those in charge will gather evidence, write reports, and make a recommendation.
If you ignore their work, you won’t have a chance to tell your side of the story. By the time someone actually contacts you, they most likely have already built a case. This only strengthens the need to have an experienced attorney on your side.
Keep in mind that a recommendation regarding the existence of medical fraud could result in criminal charges, civil lawsuits, loss of professional licenses, and more. This isn’t an area you want to take lightly.
Not Having a Healthcare Fraud Attorney on Your Team
No matter how nice they may seem, investigators are not working in your favor. They aren’t there to help you; they are there in hopes of catching illegal activities.
Just like with the police, anything you say can go into their report. Even trying to explain an innocent situation could be used against you.
Working with an experienced health care fraud lawyer will make a huge difference. Your attorney can work with the investigators directly to understand their concerns and what evidence they may have gathered.
If you meet with the investigation team, your attorney can help ensure that your rights are protected during the entire process.
Not Preparing Your Side
The investigation stage is the best time to resolve a suspicion of medical fraud. In many cases, your lawyer can help you make sure that this happens. Healthcare fraud investigators aren’t simply going to take your word. If you take the time to prepare your side of the case, you can potentially defeat the accusation against you.
This is another area where a seasoned healthcare fraud attorney will help. He or she will look at what the investigators have in their evidence files and help come up with a strong defense from there.
How to Protect Yourself
According to the FBI’s work on healthcare fraud, there are several things that patients and medical practitioners can do to prevent instances of fraud. While you should have trust in your providers, patience, and supporting staff, you should also be cautious.
For Patients
- Keep your insurance cards and benefit information safe. Only give insurance information when it’s necessary.
- Don’t accept unnecessary equipment or products. Make sure you understand why any equipment, devices, or medication is being prescribed.
- Double-check medical supplies. You should only get what was ordered; nothing more or nothing less.
For Medical Practices
- Document everything. Make sure you note why you are prescribing medications, medical equipment, etc.
- Invest in training. Since simple mistakes can result in the appearance of fraud, make sure people working with billing codes are well trained.
- Conduct regular audits to identify and correct errors.
- Have a clear policy regarding all things fraud-related.
Help is Available
Medical fraud is a serious charge. While mistakes will undoubtedly happen, you don’t want to be caught in an investigation that could have negative consequences. By taking simple steps on safeguarding your information and practices, you can protect yourself from unnecessary investigations.
If you are suspected of healthcare fraud, don’t waste time trying to deal with it on your own and hire the appropriate healthcare fraud attorney. You’ll be thankful that you did.
How the Stanford Rape Case Changed Sex Crime Laws in California
admin January 20, 2020 0 Comments sex crimes sex crimes
The sexual assault case at Stanford University sparked changes in sex crime laws in California. When Brock Turner received only six months in jail for sexually assaulting an unconscious woman on Stanford’s campus, many viewed his sentence as far too lenient. After all, the crime he had committed was heinous and had caused irreparable damage to the victim, both mentally and physically. The fact that he was given a mere six months in jail seemed to be a slap on the wrist and a far cry from the justice that many felt was deserved. It was a sentence that left many people outraged, feeling as though the perpetrator had gotten off easy. After all, the crime they had committed was one of the most heinous imaginable.
Lawmakers passed two bills in response to the situation at Stanford. While already in effect, bills AB 701 and AB 2888 continue to be debated. Some argue that these bills take a step in the direction of protecting sexual assault victims; others fear that they can be unfair to defendants who are inadequately represented. Proponents of these laws argue that they are necessary to ensure that victims of sexual assault are given the justice they deserve. They point to the fact that sexual assault cases are often complex, and the victims are often in a vulnerable position, making it difficult to come forward and seek justice. This is especially true when the perpetrator is someone the victim knows, such as a family member, friend, or even a romantic partner. In these cases, the victim may be reluctant to speak out due to feelings of shame, guilt, or fear of retribution. This fear can be especially strong if the perpetrator is someone close to the victim, such as a family member, friend, or romantic partner. Victims may be afraid that if they tell someone, they won’t be believed or taken seriously, or that they will be blamed for the abuse. They may fear that their abuser will become angry or violent if they tell someone, or that their relationship will be judged or criticized.
Here is a closer look at these new sex crime laws in California.
Stanford Rape Case Background
January 18 marks the five-year anniversary of the Standford rape case in 2015. The case and its aftermath is outlined in bullet points below:
- On January 18, 2015, Brock Turner was found on top of Chanel Miller (“Emily Doe” in the official court documents), who was unconscious and intoxicated at the time, behind a dumpster at a Stanford party.
- Turner was indicted on five charges: rape of an intoxicated person; rape of an unconscious person; sexually penetrating an intoxicated woman with a foreign object; and sexually penetrating an unconscious woman with a foreign object, and assault with intent to commit rape.
- The case went to trial a year later in 2016, and Turner was found guilty of three out of five felonies: assault with intent to rape; sexually penetrating an intoxicated person with a foreign object; and sexually penetrating an unconscious person with a foreign object.
- On June 2, 2016, Judge Aaron Persky sentenced Turner to six months in the Santa Clara county jail, plus three years of probation.
- Persky’s decision ignited public outrage, saying that the sentence he handed down was too lenient and immensely belittled the seriousness of sexual assault . A petition was started calling for his removal from court.
- The petition garnered over a million signatures by June 10, 2016, only eight days after the sentencing.
- On September 2, 2016, after only three months in jail, Turner was released on account of good behavior.
- In response to this outcry, California State Legislature moved to pass two bills changing state law on rape and sexual assault: Assembly Bill 701 broadened the definition of rape to include digital penetration; and Assembly Bill 2888 enforced a mandatory minimum prison sentence of three years for the sexual assault of an unconscious or intoxicated person.
- Judge Persky was recalled from office on January 24, 2018.
Redefining California Rape Laws
Previous laws in California defined rape as “an act of sexual intercourse accomplished with a lack of consent, force, or coercion.” This definition also applied to spousal rape. Spousal rape is a heinous crime that can have devastating consequences for the victim. It is an act of violence and power, and it is an extreme violation of trust.
However, under the old definition, rape required penile penetration. This phrasing meant the law did not account for traumatic instances of sexual assault if they did not meet the legal requirements for rape.
Previous laws also contained an element that didn’t apply to unconscious victims. While someone who lacks consciousness is unable to give consent, the former definition of rape didn’t speak directly to these situations. That means someone who assaults someone else who is unconscious from intoxication could get away with a lighter sentence.
Assembly Bill 701 looks to broaden the definition of rape. Under this AB 701, all forms of nonconsensual sexual assault could be considered as rape by law. This means that digital penetration or penetration with any foreign object counts as rape, not just penile penetration.
One of the significant benefits of this new definition of rape is that there are more resources available for survivors. Organizations and programs could now offer assistance to rape victims, without having to debate the semantics of what constituted rape.
With broader definitions of what constitutes a sex crime , more people are able to get medical, legal, psychological, and financial help they need, and a stronger shot at justice and healing.
Under California law, the crime of rape can be charged as a felony or misdemeanor. The severity of the penalty depends on the circumstances of the crime. If the victim was a minor or if serious physical injury was inflicted, the rape is charged as a felony. A felony conviction carries a sentence of up to eight years in prison and a fine of up to $10,000. In addition, California law provides for civil liability for the victims of rape. Victims may sue for damaged, including medical expenses, lost wages, and pain and suffering.
Harsher Sentences
Turner only ended up serving half of his six-month jail sentence, because previous laws allowed sex crime offenders to knock off one month on the sentence for every month of good behavior in jail. This incentive has been proven to be an effective way to encourage inmates to follow the rules and regulations of the prison system. Inmates who demonstrate good behavior can expect to be rewarded with a reduction in their sentence, providing them with a sense of hope and motivation to make positive changes. This reward system is beneficial for both the inmates and society as a whole, as it encourages inmates to take responsibility for their actions and strive to become better people.
The court has decided to offer a reduced sentence of imprisonment to sex crime offenders who demonstrate good behavior while incarcerated, with one month being taken off their sentence for every month of exemplary behavior during their period of imprisonment.
As a direct result of the lenient sentence given to Brock Turner, state legislators passed Assembly Bill 2888, which enforced a mandatory minimum prison sentence of three years for the sexual assault of an unconscious or intoxicated person.
The bill also eliminates probation as an option for sex crime offenders who assault unconscious or intoxicated persons. In the past, judges could offer probation as punishment if the victim was intoxicated or unconscious. Many argued that allowing those convicted of sex crimes to get off with probation would discourage other survivors from coming forward.
AB 2888 passed with a unanimous, 66-0 vote.
Proponents of this bill wanted to send the message that assaulting someone who is unconscious is a grave offense, one which deserves heavy consequences.
“Touching someone without their consent, especially when they are in a vulnerable state such as unconsciousness, is a serious violation of their rights and dignity, and should be treated as a grave offense with severe repercussions.”
The act of violating someone’s rights and dignity is a serious offense that should be treated with severe repercussions, and anyone found guilty of such an act should be held accountable and face the consequences, which could include being evicted from their house and barred from ever entering it again. This could mean that they would have to find a new place to live, which can be a difficult and expensive process. They would have to find a new place to store their belongings, and they may not have the money to do so.
Working Hand-In-Hand
The passing of AB 701 and AB 2888 work well together. The very concept of rape and other sex crimes has been redefined and made more inclusive. At the same time, those who are convicted of certain sex crimes may not be able to get off on probation. This is due to the severity of the crime, and the fact that the perpetrator may be considered a danger to the public. In some cases, the court may decide that the individual must serve their full sentence in order to protect the public from further harm. This is often the case when the individual has committed a particularly heinous crime, or has a long criminal history. In such cases, the court may feel that the individual is a danger to society and that the only way to protect the public from further harm is to incarcerate them.
For example, if an individual has committed a violent crime and is deemed to be a danger to society, the court may decide that the only way to protect the public from further harm is to incarcerate them; this is an example of how incarceration can be used to protect the public from those deemed to be a danger to society.
The threat posed by those deemed to be a danger to society is one of the primary reasons for incarceration, as it serves to protect the public from their potential harm and mitigate the risk of further harm from those individuals.
The effects of such protective measures are far-reaching, as they not only serve to protect the public from potential harm, but also to mitigate the risk of further harm from those individuals by reducing the effects of their negative behavior.
Let’s reimagine the original scenario of a college party. The music is loud, drinks are flowing, and people are having a good time. This might be a pretty typical weekend at any university across the country.
If at this party, another man attempts to take advantage of another drunk woman, state laws will now respond very differently.
Under the old California laws , if the man at the party rapes a conscious woman, he will go to prison. But if the man waits until the woman passes out before sexually assaulting her, all he could get was probation.
However, under the new law, if a man rapes a woman – regardless of what body part or object he uses – he would immediately receive a minimum prison sentence of three years. This number could increase based on other circumstances surrounding the assault, but it would not go lower. He would also not have the option of being put on probation.
Objections to the Changes
While both AB 701 and AB 2888 were easily passed, there are still some concerns.
Despite the fact that both AB 701 and AB 2888 were easily passed, there are still some concerns that have been raised about the changes proposed in the articles, such as the potential for increased costs and decreased access to services.
In addition to considering the potential for increased costs and decreased access to services, it is important to evaluate the benefits that may arise from the proposed changes in the articles, including any potential improvements in quality and efficiency of services.
The experiences of those affected by the proposed changes in the articles should be taken into account in order to assess the potential improvements in quality and efficiency of services, as well as any potential negative experiences that may arise.
Some crime victim advocates and associations believe that these laws might disproportionately affect poor and minority defendants who often are unable to hire a sex crimes attorney. The ACLU of California claimed that the bills were well-intentioned, but would create more injustice in an already flawed criminal justice system.
Since judges no longer have discretion, some defendants may end up with harsher sentences than they might get previously, especially if they don’t have the means to hire a reasonable attorney.
While this may seem like a good weapon against guilty parties, it can be problematic for innocent but less-privileged individuals who aren’t adequately represented. Innocent parties may take plea deals for a lesser sentence out of fear that the trial won’t go in their favor.
Faced with the possibility of a lengthy sentence, many defendants may choose to take plea deals for a lesser sentence out of fear that the trial won’t go in their favor, despite having strong defenses and evidence to support their case.
The defendants have done extensive research to ensure that their case is as strong as possible, gathering evidence and finding legal precedents to support their defense, in order to minimize the fear that the trial won’t go in their favor.
Moving Forward
The Stanford Rape Case resulted in a massive, country-wide conversation regarding sexual assault and other sex crimes . There are still people on both sides of the argument, but legislators agreed that what Brock Turner did should be considered rape and that his punishment should involve more than three months in jail and probation.
Part of the national conversation involving this case has helped more people look at their own past and actions. The hope is that this story and the changes in state laws help to discourage those who seek to take advantage of the intoxicated or unconscious.
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While there is no excuse for any breach of security that may occur, it is important to ensure that any potential security threats are identified and dealt with in a timely and effective manner, so that any security lapses can be avoided and any incidents that do occur can be addressed promptly and efficiently.
In order to protect the site from malicious activity, it is important to ensure that any potential threats are identified and dealt with quickly and effectively, paying close attention to the details of the situation in order to ensure that the appropriate measures are taken.
In order to ensure that the appropriate measures are taken, it is important to consider the context of the situation, taking into account all relevant factors such as history, current events, and potential future developments, in order to gain a comprehensive understanding of the situation and make informed decisions.
By gathering and analyzing facts, such as current trends, past experiences, and potential future developments, one can gain a comprehensive understanding of the situation and make informed decisions based on the facts presented.
These kinds of crimes can no longer offer lenient sentences. While this may not change the culture that allows rape to happen overnight, these laws, as seen by many, are a step in the right direction. Read more about sex crimes attorneys .
Medical and health care fraud are serious issues. Those who commit medical fraud can be charged with a federal crime. This could result in fines, loss of medical licenses, or jail time. That being said, if you find yourself being questioned regarding or charged with medical fraud, you need a healthcare fraud lawyer.
Here’s what you need to know about health care fraud so you can find the best representation available.
What is medical or health care fraud?
Johns Hopkins Medicine defines fraud as “Any deliberate and dishonest act committed with the knowledge that it could result in an unauthorized benefit to the person committing the act or someone else who is similarly not entitled to the benefit.”
Medical fraud or health care fraud occurs when a person or corporation knowingly and willfully use a healthcare benefit program dishonestly in order to reap a benefit or turn a profit.
While most medical professionals are honest and hard-working individuals, there are a few who try to line their pockets through illegal actions. They see their crime as victimless since it mainly impacts insurance companies.
Here are the most common medical fraud scams:
- Billing for services not rendered.
- Billing for non-covered services as a covered service.
- Misrepresenting the dates, locations, or providers of service.
- Waiving deductibles or copayments.
- Reporting of diagnoses or procedures incorrectly.
- Overutilization of services.
- General corruption, like kickbacks and taking bribes.
- Unnecessary or false prescriptions.
Health Care Fraud Lawyer
To commit fraud, a person must knowingly engage in fraudulent activities. For instance, a typographical error that results in a patient being billed for a treatment that he or she didn’t receive isn’t necessarily fraud. If, however, a provider knowingly subjects the patient to unnecessary procedures, it counts as fraud.
Keep in mind that claiming ignorance about fraud doesn’t instantly get you off of the hook. While that may be true, it’s the responsibility of insurance companies to investigate anything that looks like fraud. That means that even if you were unaware that someone else in your office is involved in a health care scam, you could still be charged.
Who Can Commit Medical Fraud?
We often think that only medical professionals can commit health care fraud. What they have to gain is clear: simply overbilling or misrepresenting information seems like an easy way to get more money from an insurance company.
However, patients can also be charged with medical fraud. They may try to game the system by faking a medical condition or using someone else’s insurance to receive services.
Punishments and Penalties
Laws vary from state to state, but medical fraud can be pursued under federal guidelines. Medical fraud can be charged as a civil crime, but it is also considered a criminal charge. That means there could be severe consequences for anyone who is convicted.
Fines
While it may seem like fraud against an insurance company is a minor crime, it can result in significant penalties.
For example, an individual who makes a false statement in a Medicare claim can be fined up to $250,000 per offense. An organization caught in ongoing schemes can be fined millions or even billions of dollars. A judge may decide that you need to pay back any amounts earned through medical schemes.
This restitution is on top of any determined fines.
Prison
As a severe offense, health care fraud can result in prison time. In 2018, the United States Sentencing Commission reported that the average sentence length for health care fraud offenders was 30 months.
Even if the resulting conviction doesn’t result in a prison sentence, it could put you on probation. While probation does mean avoiding time behind bars, it comes with its own set of rules and inconveniences.
Loss of Work
Beyond the potential career issues, you could face having been convicted of a felony, being caught in medical fraud could have other impacts.
Medical providers convicted of fraud could lose their ability to practice medicine or simply have a hard time getting hired to work for a new practice. Patients with felonious fraud on their record could lose their jobs or find it challenging to earn the trust of a new employer.
What do Do if Charged With Medical Fraud
Medical fraud is a severe offense. Even the mere accusation could have significant impacts on your career and reputation. If an investigator approaches you, don’t hesitate to contact a medical fraud lawyer immediately.
A well-seasoned attorney is the best way to navigate the treacherous waters ahead. You may be tempted to negotiate a plea deal or to try to talk your way out of trouble, but this can often result in more trouble and severe punishments.
Typically, the first sign that you’re under investigation is a letter from your Medicare carrier, Program Safeguard Contractor, or a federal agency. The message will look like you are being audited and should include a list of patient cases. These cases contain alleged overpayments or other acts of fraud.
The letter will say that you have time to compile your defense with explanations or justifications for the alleged overpayments. This is when you should contact a medical fraud attorney. They can help file an appeal or to ensure your defense is ready for trial.
You might also be served a search warrant where agents seize files. You cannot obstruct a legal search warrant, but before you let them step foot in your office, verify that they are acting legitimately. Sometimes, someone who claims to represent the government will want to see files without a warrant.
Get a copy of the person’s identification and inspect any badges that are quickly flashed in front of you. If the person does not have a warrant, schedule another time for them to visit and contact a lawyer right away. If there is a legal warrant, pay close attention to what they do and be prepared to fight it later on.
Don’t attempt to change medical records that are under review. That includes destroying or altering any file. Even if the changes are warranted, it can look like you’re trying to cover up something.
Finally, keep in mind that just because you’re being investigated doesn’t mean you did anything wrong. A patient who is accused of fraud might be the focus of the investigation, and you are merely being interviewed. Listen fully to what investigators have to say, but ensure that you have your lawyer on hand before you give them any information.
Find a Health Care Fraud Attorney
If you arrange a meeting with an auditor or investigator, make sure you have a medical fraud lawyer with you.
Don’t try to talk your way out of the situation as you might incriminate yourself, even if you didn’t do anything wrong. Before the meeting, take some time to review the patients and cases under investigation. Don’t let them confuse you; be prepared to answer any questions truthfully and consistently.
Above all, make sure you take all accusations or investigations seriously. We’re not talking about a slap on the wrist. Being convicted of medical fraud can have serious consequences. Contact a medical fraud lawyer right away; your livelihood depends on it.