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Medicare Fraud Taking a Personal Approach to Law


Defending CA Doctors & Nurses in Medicare Fraud Cases

If you are under investigation for Medicare fraud, getting in touch with a trusted Medicare Fraud Lawyer will help ease your mind. Medicare billing can be complex and it’s easy to make innocent mistakes. However, if mistakes are considered to have been made on purpose with the goal of committing fraud, you could end up in legal trouble.

Medicare billing may be handled by many individuals. Mistakes can be made at the same time another individual is attempting to defraud the system. In these situations, someone making an error may be tied in with another individual who is engaging in unethical activities.

Medicare fraud is not a new crime, but its frequency and scope seem to increase every year. There has been an unusual connection of events in the past 5 years that have made Medicare fraud crimes more common in State and Federal Court.

It is not uncommon for people who have made errors to be accused of committing fraud. The state and the federal government have become more aggressive in their efforts to reduce fraud and abuse. It is essential for you to have legal counsel if you are accused of committing Medicare fraud. Having an experienced San Diego Medicare fraud lawyer will protect you from being prosecuted for violating the False Claims Act.

Obamacare, the Affordable Care Act, and diminishing government budgets have put fraud investigations at the top of the list for State and Federal law enforcement. With more individuals now enrolled in health insurance and Medicare the frequency of healthcare fraud criminal cases is rising.

What is Medicare Fraud?

Medicare fraud is a term that covers a number of activities and it isn’t limited to just Medicare. It is defined as a payment being made by the federal government to a business, entity or provider as the result of a false claim being filed. This type of fraud is a federal offense, and it can carry both severe civil and criminal penalties.

Activities involving defrauding a federal healthcare program, including Medicaid, Tricare, and federal worker’s compensation, may be considered Medicare fraud.

In addition to filing false claims, Medicare fraud involves violating one or more of the following:

  • Physician Self-Referral Law (also known as Stark Law)
  • False Claims Act
  • Anti-Kickback Statute
  • U.S. Criminal Code
  • Social Security Act

San Diego Attorney George Gedulin describes Medicare fraud, “This type of fraud is similar to any healthcare fraud offense, the prosecution accuses a physician or healthcare facility owner of submitting claims for reimbursement of medical procedures which were duplicative, unnecessary, or simply were never performed.”

Who Can Commit Medicare Fraud?

Medicare Fraud may be committed by practitioners as well as Medicare members and patients.

A practitioner Medicare fraud may comprise of:

  • Obtaining subsidized or fully-covered prescription pills with the intent of selling them on the black market.
  • Practitioners billing for care that was never provided.
  • Filing duplicate claims for the same services. This may involve changing dates or descriptions of services, or changing the identities of members and providers.
  • Submitting a bill for a non-covered service by listing it as a service that is covered.
  • Intentionally reporting incorrect diagnoses or procedures in an effort to increase payment amounts.
  • Using unlicensed staff.
  • Accepting or giving kickbacks for member referrals.
  • Waiving co-payments for members.
  • Prescribing unnecessary treatments.

Medicare fraud by members can involve:

  • Providing false information when applying for programs or services.
  • Forging prescriptions or selling prescription drugs.
  • Using transportation benefits for non-medical related purposes.
  • Loaning out an insurance card or using another person’s insurance card.

Medicare Fraud Charges in California

Medicare Fraud is a federal crime. The cases often involve federal offices, such as the Office of Inspector General for the U.S. Department of Health and Human Services, the Federal Bureau of Investigation and other U.S Department of Justice Enforcement groups. However, Medicare fraud may be considered a misdemeanor or a felony depending on the circumstances.

Federal Statutes for Healthcare Fraud under 18 U.S.C. Section 1347

It is illegal to conspire or create a system to defraud any healthcare program. The fraud can be committed in any way, false claims of work done, performing medically unnecessary procedures or simply double billing for work already done.


18 USC 371: Federal cases often involve the serious charge of conspiracy. If at least one other person was involved in the Medicare fraud the government can charge felony conspiracy, which has a penalty of five years in prison.

CA Healthcare Fraud, CA PC 550

  • The California laws deal more often with fraudulent claims submitted to insurers.
  • Bills sometimes submitted for procedures not actually performed, or claiming that more expensive medicine or equipment was used.
  • Defense of medical offices accused of submitting claims for services that were never performed.
  • Duplicate or follow-up claims, asserting that multiple procedures were performed on a patient when only one had been completed.

San Diego Fraud Attorney George Gedulin has defended doctors and nurses accused of multiple felonies. Standing up for those innocent healthcare workers and physicians who were accused of wrongdoing when they had no knowledge or part in the healthcare fraud conspiracy. Recent changes in California have allowed George to protect the careers of his clients by arguing against felony sentencing and penalties.

California Medicare Fraud Penalties

In California, fraudulent claims involving amounts of less than $950 over the course of a 12-month period are considered to be misdemeanors. In situations where the cumulative amount of claims is greater than $950, someone may face misdemeanor or felony charges.

If someone faces misdemeanor Medicare fraud charges for less than $950 of fraudulent claims, they face a maximum fine of $1,000 and/or up to six months in county jail. For claims amounting to more than $950, a misdemeanor Medicare fraud conviction can result in up to one year in county jail and/or a fine of no more than $10,000.

When someone faces felony charges, they may be sentenced to up to five years in county jail per offense. Fines are up to $50,000 or double the amount of fraudulent claims. The fine amount will depend on which claim is the largest.

Legal Defenses for Medicare Fraud

  • Knowledge of the crime and Intent are the key to any fraud case
  • Our strategy has helped clients facing years in prison and thousands in restitution for acts committed by others

Among the biggest agencies that investigate fraud is the Health and Human Services agency. HHSA is the largest single employer in the state of California and conducts thousands of investigations for entitlement fraud.

Medicare Fraud Strike Force

The Medicare Fraud Strike Force is a federal agency comprised of investigators and prosecutors from other federal organizations, including the Department of Justice, the Department of Health and Human Services and the Office of Inspector General. The job of the strike force is to monitor, investigate and prosecute violations of the False Claims Act.

San Diego is home to many people who rely on federal healthcare programs. The area has a high amount federal government claims. Due to the volume of claims, the city is one of nine areas directly monitored by the Medicare Fraud Strike Force. This direct monitoring means claims undergo much greater scrutiny for False Claims Act violations than claims from other areas.

Medicare Fraud Prosecution Increasing

Medicare fraud cases are prosecuted at the State and Federal level every day. In July 2014 a man was indicted in the Central Federal District of California for conspiracy, Medicare fraud, and identity theft. The scheme was not more complex than most operations that seek reimbursements for healthcare facilities from the government by submitting fraudulent claims. In this case, the individual submitted thousands of false claims to State Medicare office using the identities of individuals without their knowledge. These claims were for medical services never performed, and without a single patient being seen. Ultimately the case went to trial with the defendant being sentenced to pay millions in restitution and serving 121 months in Federal Prison.

Our firm has helped men and women save their careers in the face of serious criminal accusations. Felony charges, if not handled properly, can result in a lifelong ban from the practice of medicine or nursing. Experienced counsel is always key in any federal or state criminal matter.

Local and Federal budgets were cut dramatically following the economic downturn of 2008 and 2009. States with ever decreasing resources to supply necessary aid to low income and disabled were in a difficult situation. In this time the State and Federal government began looking to its enforcement and investigations departments to go after criminal wrongdoing and fraudulent use of the entitlement system. The pressure from District Attorney and FBI offices is immense to prosecute cases, a strong defense is a right which should always be exercised.

Contact a San Diego Medicare Fraud Lawyer Today!

If you’re accused of Medicare fraud, you can expect to be interrogated by government officials. Due to the increasing demand for reduction in fraud, prosecutors are praised when they obtain convictions that prevent hard-earned taxpayer dollars from being wasted. It is easy for you to become a scapegoat if you are accused of committing Medicare fraud.

A San Diego Medicare fraud lawyer can aggressively defend and protect individuals who have been accused of Medicare fraud. Lawyers can help patients, physicians, nurses, and other medical professionals deal with unjust, complex or incriminating questions from government officials. Additionally, lawyers are able to work to get charges reduced or dismissed altogether.

Contact us today to discuss your case with our San Diego Medicare fraud attorneys by calling (858) 281-4605!

Case Results

  • Sentence Reduced, All Other Charges Dropped 16 Counts, Unlawful Sexual Intercourse with a Minor

    Client charged with multiple sexual assault offenses, facing 16 years in prison. Convicted of One Count of Sex with a Minor, 2 years Jail, All other charges dismissed.

  • Reduced Sentence, Other Charges Dropped 24 Count, Insurance Fraud Conspiracy, Grand Theft in excess of $250,000

    Client charged as head of conspiracy to present false claims to insurance companies, losses over $250,000. Client facing 22 years in State Prison. Convicted of two counts of insurance fraud, sentenced to 2 years in jail, remaining charges dismissed.

  • Dismissed with No Jail Time, Probation Only Assault with Deadly Weapon, Robbery, Burglary

    Client charged with multiple counts, potential 14 year sentence. Released with no custody.

  • Dismissed Charges Assault with semi-automatic Firearm, Criminal Threat, Domestic Violence

    Charges exposed client to 8 years in State Prison and two serious strike felonies. Court dismisses all gun related charges at preliminary hearing, client pleads to domestic violence charge only, no custody.

  • 30 Days Probation, Case Dismissed. Attempted Murder

    Client charged with Attempted Murder in connection with the death of her husband suffering from a fatal illness. Defense investigation revealed that statements of witnesses were unreliable and unfounded.

Client Testimonies

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