Los Angeles Health Care Fraud Defense Lawyer

Since it was established in 1965, Medicare has become one of the largest components of the federal budget. More than $500 billion is spent on providing medical care and prescription drug coverage to seniors. With so much money flowing through the system, it is no surprise that federal law enforcement agencies aggressively monitor that doctors, hospitals, and other recipients of Medicare funds receive only the money they are entitled to. That is one reason why federal prosecutors aggressively go after people and entities that have committed fraud or are suspected of otherwise providing false or misleading information in an attempt to receive Medicare reimbursements and other federal health care payments.

At the Law Offices of Jerod Gunsberg, we use our knowledge of and experience in Los Angeles federal courts to defend those who have been charged with Medicare, Medicaid, or other forms of federal health care fraud.

What is Medicare Fraud?

Under federal law, the act of providing inaccurate information in connection with an effort to receive Medicare or related reimbursements can be a serious crime. Specifically, anyone found guilty of intentionally providing false information in violation of The False Statements Act (18 U.S.C. 1001), can face up to five years in jail as well as a sizeable fine. Under the federal sentencing guidelines, the prison time can be higher depending on the amount of loss.

Likewise, the Social Security Act contains an anti-kickback provision, which makes it a felony to pay kickbacks, refunds, or bribes to seek Medicare reimbursement. Penalties for violating the anti-kickback provision include up to a five-year prison sentence and up to a $25,000 fine. People charged with Medicare fraud may also be charged with violating the federal wire and mail fraud statutes, which carry their own prison sentences and fines.

Different Kinds of Health Care Fraud Cases

Because the health care delivery system is so complex, there are many potential ways for someone to be charged with Medicare or other forms of health care fraud. Perhaps the most common cases involve allegations that the defendant either didn’t perform tests or provide services that were submitted for reimbursement (“phantom billing”) or that lower cost equipment was used or a lower cost service was provided when reimbursement was sought for higher cost equipment or services (“Upcoding,” “Code jamming” “Double billing” or “Unbundling”).

Whether federal prosecutors allege that no services were provided or that reimbursement was sought at too high a price point, defending health care fraud cases generally involves challenging two aspects of the prosecutor’s charges. First, health care fraud cases tend to be much more document intensive than the typical criminal case. Much of the evidence in Medicare and other health care fraud cases involves reimbursement forms and related documents. Thus, it is necessary to review every single document that federal prosecutors rely on as well as other documents that they may have overlooked. Second, to prove a case of health care fraud, prosecutors must show beyond a reasonable doubt that the accused intended to commit a fraud at the time they submitted the reimbursement reports or related information. It is not sufficient to show that the information provided was inaccurate or that payments may have been received in error.

Health Care Fraud and Conspiracy

The FBI and other federal law enforcement agencies tend to focus on cases where large numbers of people can be accused of agreeing to commit Medicare or other forms of health care fraud. If you are found to be part of the conspiracy, you can be found guilty of all the crimes committed by any member of the conspiracy. Because of how federal conspiracy law works, you can be accused of being part of a conspiracy even if you don’t know other members of the conspiracy and don’t know what they did. Federal law enforcement agencies use a variety of tactics to encourage individuals to share incriminating information about other members of the alleged conspiracy. It is therefore critical that you don’t talk to law enforcement agents before first speaking to an experienced criminal defense lawyer.


Health care fraud is a good example of how federal crimes and federal courts are different than California courts. Medicare and Medicaid fraud are federal crimes. Most criminal defense lawyers aren’t familiar with federal law.

Given how extreme the potential punishments are under federal law for health care fraud, it is critical that you work with an experienced federal health care fraud defense lawyer who has local expertise in federal courts. Whether your situation involves the FBI or any other federal agency, or whether you may only be a “witness” in a health care fraud case, or whether you have been accused of being more actively involved in a federal health care fraud conspiracy, the Law Offices of Jerod Gunsberg will aggressively defend any health care fraud-related charge based on our extensive experience in the Federal courts in Los Angeles, Orange County, and Riverside.

For a confidential consultation, call Los Angeles health care fraud defense lawyer Jerod Gunsberg at (323) 633-3423 or get in touch via the secure contact form on this page. Help is available 24 hours a day, 7 days a week.

Let's talk