Orange County Medical Insurance Fraud Attorney

Please note that the Law Office of Michael Guisti is a Criminal Defense Firm and we do not represent Victims of Fraud. We represent those who have been arrested for or charged with a Fraud Crime.

Get Legal Help After an Arrest for Medical Insurance Fraud

If you have been charged with medical insurance fraud you stand to lose a great deal both professionally and personally. Though individuals accused of fraud generally don’t face the same level of punishment as those convicted of violent crimes, someone charged with medical insurance fraud may face harsh sentences. Licensing and credentials may be suspended or revoked; you might land in prison, hindering your future livelihood.

Medicare, Medicaid and private medical insurance report a combined $100 billion lost to medical insurance fraud costs annually. In recent years, the federal government has increased efforts to prevent healthcare fraud committed by healthcare providers and professionals. Fraud schemes are not victimless; state and federal statues outline stiff punishment for those convicted of healthcare fraud and its related crimes, such as mail or wire fraud. Additional charges give prosecutors more leverage in medical insurance fraud cases.

Back to Top

Who Can Be Charged With Medical Insurance Fraud?

In California, it’s not only physicians and doctors who are vulnerable to medical insurance fraud charges. The following entities can be charged with medical insurance in the Golden State:

• Doctors
• Pharmacists
• Medical Supply Companies
• Medical Equipment Companies
• Billing Managers
• Accountants
• Hospitals
• Clinics
• Parent Companies/Umbrella Companies
• Third Party Billing Companies

If you’re convicted of medical insurance fraud, you can be sentenced to up to five years and be fined up to $50,000 (or double the amount of the fraud, whichever amount is larger). California law also requires the guilty party to provide restitution of the fraud amount in addition to legal penalties.

To avoid these types of penalties, you’ll need strong legal counsel that has the experience, dedication and resources to effectively defend your interests. Contact Law Office of Michael L. Guisti today and learn more about your potential defense options. Call (714) 530-9690 to speak with a member of our criminal defense team today.

Back to Top

What Are Some of the Most Common Forms of Medical Insurance Fraud?

Here are a few examples of activities that agencies such as the California Department of Insurance Fraud will typically investigate. Many of these types of crimes are often confused with legitimate medical billing procedures:

• Fraudulent Billing - A healthcare provider bills an insurer (Medicare, Medicaid and private medical insurance) for a service an insured patient never received. While this could be the result of an illegal action, it could also have occurred because of a simple clerical error.
• Medical Equipment Billing - A healthcare provider bills an insurance company for some equipment that the insured party doesn't need or never receives. Similar to fraudulent billing.
• Coding Errors - Though the majority of coding errors are unintentional, a person employed by a healthcare provider intentionally changes a billing code to a more expensive service. (This practice is referred to as "upcoding.") The insurer pays a higher amount than actually due. Single cases or reported incidents aren’t usually prosecuted, but multiple reported errors will bring a doctor or healthcare provider under investigation.
• Unbundling/Exploding - The practice of administering medical tests to patients in order to increase overall costs billed to insurers. This activity could be the result of unethical medical practices, or it could be that medical tests were dictated by patient necessity.

Back to Top

Why Should I Contact Law Office of Michael L. Guisti?

The most effective way to fight a medical insurance fraud investigation in California is to consult with an experienced attorney. At Law Office of Michael L. Guisti, our top Orange County fraud defense lawyers understand how medical insurance fraud crimes are prosecuted and can build a strong defense on your behalf. If you are a healthcare provider, or work in the medical field, and have been investigated or charged with a medical insurance fraud offense, please contact us at (714) 530-9690 immediately. Your career - and your freedom - may depend on getting top legal representation.

Back to Top