Worker’s Compensation Provider Fraud

Worker’s Compensation Fraud Criminal Defense Attorneys

Dmitry Gurovich and Elon Berk are the managing partners of Gurovich, Berk & Associates, a criminal defense law firm that represents medical professionals. Mr. Gurovich and Mr. Berk have  38 years of combined experience defending their clients from Worker’s Comp Fraud, Medicare, and Medicaid Fraud charges. Unfortunately, these charges occur too frequently among providers, and most have absolutely no idea what they did to warrant such accusations. Prosecutors also routinely over-charge providers- they know they might have to settle for lesser charges after  plea bargaining with the defense team. This is why it’s crucial to take action against any and all accusations. It’s in your best interest- your reputation, business, and liberty are on the line.

Mr. Gurovich and Mr. Berk have knowledge and experience of the medical industry. They are privy to the business structures of hospitals, pharmacies, and third parties involved in the industry. In addition to this strategic interaction with various medical-industry players,  they are sensitive to the crucial nuances that many attorneys are oblivious to- such as the vast array of different provisions and policies specific to every insurance company. They have inspected governmental RAC and ZPIC audits with PI’s and analyzed hundreds of insurance claim forms. Mr.Gurovich has been invited to give presentations to providers. In these conventions, he is invited to inform medical professionals of crucial health care rules, regulations, and laws- which not knowing can cause them to intentionally “commit a crime.” In investigations, knowing these rules and when they were put into effect is a way to determine whether a provider actually committed the violation the government is charging him of. Mr. Gurovich and Mr. Berk’s experience and knowledge in the medical industry- on the industrial and atomic levels, ensure  best possible defense will be formulated for you and your case. Give us a call. (818) 205-1555. We’re interested to hear your case.

 

About Worker’s Compensation Fraud

Healthcare Fraud has been heavily prosecuted for many years. Recently, however, there has been increased political pressure to combat these violations because the impact to insurance companies and government programs is so substantial. This has resulted in an increase in the number of cases filed.

As a result of this new effort against Healthcare Fraud, many legitimate providers are experiencing a chilling effect and are reluctant to practice medicine and to bill as they once did.

What Constitutes the Crime?

In order to be convicted of healthcare fraud, the prosecution must prove all of the following elements:

  • You submitted false or fraudulent claims to the insurance company
  • You knew the claims were false or fraudulent
  • You intended to defraud the medical insurance company

The most common types of Healthcare Fraud is billing for services not rendered, or billing for services rendered but that were not medically necessary. In both instances the provider’s intent is at issue and must be determined. This is done by examining various factors such as the necessity of the procedures billed, whether the patient’s file has complete records, patient’s medical history, the relationship between the provider and other individuals associated with the practice and many other such factors.

What can lead to health care fraud charges?

  • Submitting claims for services that weren’t rendered
  • Submitting false claims
  • Submitting multiple claims
  • Prescribing unnecessary medicines
  • Ordering unnecessary patient tests
  • Upcoding

Penalties

Although health care fraud can be filed as a misdemeanor if the loss is less than $950.00, the vast majority of these cases are felonies.

If the prosecution chooses to charge you with a felony, you face:

  • A maximum fine of $50,000, or restitution worth double the defrauded amount
  • A prison sentence of two, three, or five years in a county jail
  • A jail sentence of up to one year and fines

Legal Defenses to Healthcare Fraud Charges

Lack of Intent Defense- Submitting a false claim, by itself, is insignificant without establishing an intent to defraud. If the provider had a good faith belief that the procedure was medically necessary, or if there was a glitch in the computer system, for example, it would negate criminal intent.

Mistake of Fact Defense- This defense applies when a false or duplicate claim was mistakenly submitted. Billing the insurance company for the wrong service could have been an honest mistake.