Ventura Health Care Insurance Fraud Attorney 

Health care and insurance fraud can take many forms, but one of the most common involves people receiving benefits they shouldn’t or charging services that weren’t provided. Whether you are being accused of making false statements to receive medical benefits and kickbacks through health care claims – or even have been charged with the illegal possession and use of medications or medical equipment, you need legal advice from an experienced Ventura health care insurance fraud attorney.

Read more below to learn:

• Ventura Health Care and Insurance Fraud Law
• What the Court Has To Prove In Order To Get A Conviction
• Ways to Defend Against Health Care and Insurance Fraud Charges
• Health Care and Insurance Fraud Penalties and Types of Fraud
• Real-Life Example for Health Care and Insurance Fraud Charges
• Contacting a Health Care and Insurance Fraud Lawyer For Immediate Help

Ventura Health Care and Insurance Fraud Law

Healthcare fraud can take many forms and can affect us, in one way or another. Charges under Insurance Code Section 1871.4 and Penal Code Section 550 focus on the person submitting the insurance claim making false statements to either obtain or deny the insurance benefits. Since these alleged false statements are then being used to get health insurance benefits, the person accused could possibly face what is called perjury, under Penal Code Section 118. Essentially, perjury is the intentional act of swearing in a false oath or even falsifying an affirmation to tell the truth.

These claims call for immediate action in contacting an experienced Ventura County Health Care and Insurance Fraud Attorney.

What the Court Has to Prove in Order To Get A Conviction

The law says that in order to get a conviction for health care insurance fraud, criminal court must be able to prove beyond a reasonable doubt that you were involved in two (2) things: First, someone must have committed fraud by lying about certain aspects of the healthcare, and second, you or the person in question knew about it. Prosecutors need to convince a jury that both these elements are true.

Let’s look at each one separately:

First, the court has to show that someone lied about certain aspects of your healthcare—like saying they did or didn’t perform a medical procedure when they really did or didn’t. This may seem straightforward, but there are several different ways you can commit fraud related to your own healthcare. For example, an overbilling scheme involves billing patients for services not rendered or at rates higher than what was agreed upon with Medicare or private insurers. Meanwhile, upcoding means doctors bill insurers for more serious diagnoses than what’s been confirmed through diagnostic tests like MRIs and X-rays—which can result in greater reimbursement from Medicare or private insurers.

You may be tangled in this either through the medical center you work for or through being a patient. Either way, obtaining an experienced Health Care Fraud and Insurance Lawyers in Ventura would be your first step in ensuring you are on the correct path to defending yourself.

Ways to Defend Against Health Care and Insurance Fraud Charges

If you’re facing allegations of health care fraud, then there are several ways to defend yourself against them.

A Ventura health care insurance fraud attorney can help protect your rights by investigating whether or not your actions were truly fraudulent, while also consulting with you on how to handle any charges levied against you.

It’s important to remember that being accused of committing health care insurance fraud is not proof that you did so. In fact, even if you’ve been charged with committing insurance fraud, it doesn’t mean that you will be convicted—or even charged at all.

That said, one way to defend yourself from such accusations is by proving that your alleged actions weren’t fraudulent in nature. To do so: Document everything. Keep thorough records regarding anything related to billing and claims for reimbursement from Medicare, Medicaid or your respective insurance carrier. This includes your own files and documentation of visits/services provided as well as correspondence between you (the client) and the providers/insurance companies.

Always make sure you communicate any questions or concerns you have with an experienced health care fraud attorney before the legal issues compile.

Health Care and Insurance Fraud Penalties

In most California courtrooms, health care insurance fraud penalties can be severe and often involve time in prison. However, a skilled Ventura health care fraud attorney may be able to negotiate more favorable terms, depending on exactly what happened and what is proven in court.

Penalties for health care insurance fraud include either misdemeanors or felonies and this is all dependent on the total amount of questionable claims that get submitted to the insurance companies.

The crime for health care insurance fraud in Ventura County is typically between five to 10 years in jail or prison.