My experience as a Deputy District Attorney, Deputy Attorney General and as a private defense attorney handling primarily criminal fraud allegations against health care providers for over 25 years can help you, the provider, if such allegations are made against you or your practice by government agencies or private insurers. I have prosecuted numerous cases while in the California Attorney General’s Office and know the ins-and-outs of the investigative process and the criminal charging and prosecution stages. I know that in spite of how strong the government’s case may seem at first glance, that there are many defenses. These defenses when properly and timely raised may avoid the filing of criminal charges altogether or a successful criminal defense should charges ultimately be filed.
If the allegations have merit (i.e. you are guilty), you are still entitled to a full defense which may result in having your criminal charges reduced or thrown out entirely. Engaging a knowledgeable criminal defense attorney immediately is critical to enhance your bargaining position and asserting your legal rights. You NEVER have to plead guilty or cooperate with investigators even though you WILL receive a lot of pressure to do both. Sometimes full cooperation is the best defense, but you should not make that decision on your own.
Private insurers also have teams of investigators and auditors reviewing Explanations of Benefits (EOB’s), medical records and patient complaints. These professionals often have government backgrounds and may be very good at their jobs. An immediate consequence of such an investigation can be your removal as a provider from the panels of providers approved by the insurance company. You cannot afford to take these private investigations by an insurance company lightly. However, you have rights, both administratively and of course criminally should the insurance company refer the case to a governmental agency for prosecution. You have to be careful how you respond to the insurance companies investigations and look beyond the immediate consequences. Again, you NEVER have to cooperate, but you WILL suffer consequences if you fail to cooperate. Let me help before it gets that far.
I represent providers in a broad spectrum of the health care field. In the past I have represented physicians, nurses (RN and LVN), dentists, dental hygienists, laboratory directors, laboratories, physical therapists, acupuncturists, adult day health care facilities, health care non-profits, pharmacists and pharmacies.