Criminal Defense
Oakland Healthcare Fraud Defense Lawyer
max@dotcomlawyermarketing.com
Legal Expert
8 min read
Updated: Sep 6, 2025
You're here because you or someone you care about is facing healthcare fraud charges. It's a serious situation - one that could potentially derail your career and future. But you've come to the right place.At Spodek Law Group, we understand what you're going through. We've defended countless clients against healthcare fraud allegations in Oakland and across the nation. Our healthcare fraud defense team is comprised of aggressive litigators who leave no stones unturned in pursuit of justice.We know the stakes are high; that's why we fight tirelessly to have charges reduced or dismissed entirely. When prosecutors come after you, we respond with force - crafting airtight defense strategies tailored to your unique circumstances.This article will provide an in-depth look at healthcare fraud charges and how our Oakland defense lawyers can help protect your rights and freedom. We'll explore:
- Common types of healthcare fraud schemes
- Potential penalties you could face
- Proactive defense strategies we employ
- Why you need elite legal representation
What Constitutes Healthcare Fraud? Common Schemes to Be Aware Of
Healthcare fraud encompasses a wide range of conduct aimed at defrauding public or private healthcare benefit programs. At its core, it involves knowingly executing or attempting to execute a scheme to:- Defraud a healthcare program like Medicare, Medicaid, etc.
- Obtain money/property from a healthcare program through false pretenses
Billing for Services Not Rendered
This occurs when a provider bills a healthcare program for services, procedures or supplies that were never actually provided to the patient.Upcoding
Upcoding refers to billing for a more expensive service than was actually performed. For example, a provider might bill for a higher-level office visit despite only conducting a minor examination.Unbundling
Unbundling involves billing each component of a service as a separate charge when they should be billed together under a single code.Kickbacks
Offering or receiving anything of value in exchange for patient referrals is considered a kickback and is illegal under the Anti-Kickback Statute.Falsifying Patient Records
Altering patient records to justify services that weren't medically necessary or to make it appear a service was provided when it wasn't.Prescription Fraud
This can include writing prescriptions for drugs the patient doesn't need, billing for higher quantities than prescribed, or distributing controlled substances illegally.The list goes on - from billing for outdated services to excessive services not medically warranted. Essentially, any attempt to overcharge or receive reimbursement through deception can constitute healthcare fraud.Charges often stem from whistleblower complaints or data mining by federal agencies. But innocent billing errors can also raise red flags, leading to a costly investigation.That's why you need a skilled Oakland healthcare fraud lawyer from the moment you become aware of allegations or an audit. We can intervene early and ensure your rights are protected.You Could Face Devastating Penalties - Your Entire Livelihood at Risk
If convicted of healthcare fraud, you're facing potentially devastating penalties that could destroy your career and future. Punishments can include:Federal Prison Time- Up to 10 years for each healthcare fraud count
- Longer sentences if higher dollar amounts are involved
- Up to $250,000 in fines per healthcare fraud violation
- Repayment of claims paid, plus up to triple damages
- Potentially barred from participating in Medicare, Medicaid, etc.
- Medical, nursing, other professional licenses could be suspended/revoked
- Public shame that could irreparably harm your personal/professional reputation
Proactive Defense Strategies to Fight Healthcare Fraud Charges
When you hire Spodek Law Group, we spring into action immediately, executing a multi-pronged defense approach tailored to your unique situation. Here are some of the key strategies we may employ:Lack of Intent- We'll argue you had no intentional scheme to defraud
- Billing errors, misunderstandings, or lack of training don't prove intent
- Aggressive prosecutors often pursue charges that don't fit the crime
- We'll push back against overcharging and disproportionate penalties
- If you were induced into committing fraud, we can argue entrapment
- Undercover stings or reliance on shady informants could be entrapment
- We'll scrutinize how evidence was obtained and its admissibility
- Improper searches, unauthorized wiretaps, etc. could get evidence tossed
- Following advice of a supervisor, lawyer or compliance officer negates intent
- We can argue you acted in good faith based on professional guidance
- We'll file motions to dismiss charges or suppress key evidence
- Poking holes in the prosecution's case from the outset
Why You Need an Elite Oakland Healthcare Fraud Defense Lawyer
Choosing the right legal team is crucial when facing healthcare fraud charges. These are highly complex cases that require strategic maneuvering and in-depth knowledge of healthcare laws and regulations.At Spodek Law Group, our healthcare fraud defense attorneys have:- Decades of combined experience in state/federal courts
- Extensive background handling healthcare fraud cases
- Comprehensive understanding of healthcare laws like Stark, Anti-Kickback, etc.
- Proven track record of getting charges reduced or dismissed entirely
- Resources to go toe-to-toe with powerful federal prosecutors
- A dedicated defense team singularly focused on your case
- Proactive strategies to resolve charges favorably
- Open communication and transparency from day one
- Aggressive negotiation and litigation when needed
- Tireless commitment to protecting your rights
Potential Scenarios and Defense Approaches
To give you a better sense of how we operate, let's walk through some hypothetical healthcare fraud scenarios and potential defense approaches:Scenario 1: Billing Errors Lead to an InvestigationYou run a small medical practice. During a routine Medicare audit, it's discovered that your staff made coding errors on a number of claims over the past year - resulting in $75,000 in overpayments.The auditors immediately assume fraud and refer the case to federal prosecutors for criminal charges. But you had no knowledge of the errors, which were simply mistakes made by undertrained staff.Our Defense Approach:- Argue lack of intent to defraud - coding errors don't prove criminal intent
- Highlight your practice's compliance program and training procedures
- Negotiate with prosecutors to have charges reduced or dismissed entirely
- Push for a civil repayment agreement instead of criminal prosecution
- Attack the whistleblower's credibility and motives for filing suit
- Scrutinize the methods used to obtain evidence against you
- Argue any payments were legal "rebates" rather than illegal kickbacks
- Negotiate for deferred prosecution or pre-trial diversion program
- Hire expert medical witnesses to counter prosecution experts
- Argue any record discrepancies were unintentional/sloppy paperwork
- Highlight your history of providing quality care to undermine allegations
- Negotiate for reduced charges/sentencing in exchange for cooperation
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