Employers, employees, and healthcare providers can all be accused of workers’ compensation fraud in Los Angeles. However, simply facing an accusation does not mean you will be convicted. Investigators frequently level charges where no one intentionally committed fraud.
If you do face charges, though, you should be aware that even a single conviction can carry years in jail and a massive fine of $150,000 or more. If you have been accused of fraud, you need to fight the charge. The Simmrin Law Group’s workers’ compensation fraud lawyers in Los Angeles can help you.
What Counts As Workers’ Compensation Fraud in Los Angeles?
Workers’ compensation fraud is a specific fraud charge covered by the California Insurance Code, Section 1871.4. Charges can be brought under this law against the employee who claimed to be injured, the employer handling the injury claim, or the healthcare provider that billed the insurance company for treating the injury.
The charges and penalties are the same for any of these parties. However, only the party actually suspected of fraud should be charged. An employee can be completely innocent in a case of fraud committed by the employer, for example, and vice versa.
No matter which party is accused, workers’ compensation fraud basically means any attempt to:
- Falsify documents to collect benefits
- Make false statements in order to collect benefits
- Fabricate an injury to collect benefits
You can also be charged and convicted if you simply aided someone else in committing fraud, even if you never stood to benefit. Similarly, you can be convicted if you never actually received money from the scheme. Simply attempting to carry out workers’ compensation fraud is enough to make you guilty in the eyes of the court.
For a free legal consultation with a workers' compensation fraud lawyer serving Los Angeles, call (310) 896-2723
What Are the Penalties for Workers’ Compensation Fraud in Los Angeles?
Workers’ compensation fraud is a white-collar crime and can be charged as either a misdemeanor or a felony. The choice is up to the prosecutor, and will generally reflect both your past criminal history and how serious or costly the fraud was.
The penalties depend on how the fraud is charged. A felony conviction will bring much steeper penalties than a misdemeanor charge. However, this does not mean that a misdemeanor conviction is a simple slap on the wrist. A misdemeanor charge can still result in life-changing consequences.
Misdemeanor Penalties
The penalties for a misdemeanor charge of workers’ compensation fraud can include:
- Up to one year in jail
- A fine of up to $150,000 or twice the amount of the fraud (whichever is higher)
- Paying restitution for any money you were able to successfully defraud
- Summary probation
Felony Penalties
The potential penalties for a felony workers’ compensation fraud conviction can be much tougher, including:
- Up to five years in prison
- A fine of up to $150,000 or twice the amount of the fraud (whichever is higher)
- Paying restitution for any money you were able to successfully defraud
- Formal probation
As you can see, even a single first-time conviction can potentially ruin a life and end a career.
If convicted for a felony fraud charge, you will also carry convicted felony status. A felony conviction makes it hard to apply for jobs, may prevent you from earning professional licenses, and affects your basic rights. For instance, convicted felons are not allowed to own a gun.
Professional Repercussions
If you are a medical provider of any kind, be aware that you could face professional penalties in addition to these criminal consequences. You may have your professional license suspended or revoked if you are convicted of a workers’ compensation fraud charge.
Because the penalties for a conviction can be so severe, we urge every person accused of fraud to get professional legal help from a Los Angeles workers’ compensation attorney and attack the charges.
Los Angeles Workers' Compensation Fraud Lawyer Near Me (310) 896-2723
What Must the Prosecution Prove in a Criminal Workers’ Compensation Fraud Case?
Even if you have been accused, you cannot be convicted unless the prosecutor proves their case. Under the law, they must demonstrate several specific facts. In order to prove your guilt, the prosecution must be able to show that:
- You made a “material representation” about a claim, including billing for it, or made a statement about any of the facts of the claim (or about the eligibility of a worker).
- Your statement or representation was false.
- You knew it was false when you made it.
- You made it to defraud the workers’ compensation system, to obtain benefits for a worker that is not eligible, or to prevent an eligible worker from making a claim.
The prosecutor must prove all four of these elements. Even if they make a good argument for three of these elements, failing to demonstrate that the fourth is also true should mean that you beat the charge.
The prosecutor has to do much more than prove that your claim was false or erroneous. They have to show that you knew it was untrue and that you intended to defraud the system.
This gives you and your criminal defense lawyer an advantage. Prosecutors come into fraud cases relying largely on medical records and internal business records. These records can easily show that a claim was incorrect or that statements about it were wrong.
However, on their own, these records have a hard time establishing that the falsehoods were part of an intentional plan to commit fraud. This is where a good defense against a fraud case usually starts.
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How Does a Criminal Defense Lawyer Fight a Workers’ Compensation Fraud Charge?
There are many potential defenses against a workers’ compensation fraud charge. The approach your Los Angeles workers’ comp fraud lawyer chooses to take will depend upon the specifics of your case. While there are several possible defenses, in most cases, defense attorneys stick to a few basics. The most common defenses we see work in workers’ comp fraud cases are:
- No knowledge of fraud
- No intent
- Lack of evidence
No Knowledge of Fraud
Sometimes, false statements made in workers’ compensation claims are honest mistakes. You believed that what you were saying, writing, or billing for was accurate. Accidentally providing false statements does not constitute committing fraud. The law recognizes that there are several reasons why a person may accidentally present inaccurate information.
No Intent
In order to be convicted of fraud, you must have acted with the intent to defraud. Submitting a claim the way your employer tells you to is not fraud, even if it is inaccurate. Likewise, coding or billing a claim to the insurer is not fraud if you are simply coding it the way you were trained to, not realizing it is wrong. Mistakes or poor record-keeping are not grounds for conviction.
Lack of Evidence
Sometimes the prosecutor simply does not have the documentation to back up the narrative they want to tell. In these situations, it may be possible to get the entire case dismissed or to simply get a victory.
However, the correct defense will depend on whether you are the worker, the employer, or the provider. It will also depend on what happened and what facts the prosecution is relying on against you. If you are facing this kind of charge, you cannot risk facing it alone. You need to talk to a lawyer.
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Talk to a Los Angeles Workers’ Compensation Fraud Lawyer for Free
Do not let a fraud accusation ruin your life or your business. The Simmrin Law Group can help you. Our team of highly trained Los Angeles workers’ compensation fraud lawyers has plenty of experience with these cases.
We understand the complicated rules of workers’ compensation and how fraud investigations work. We know that you face not only criminal consequences but also repercussions for your career or business. We have a history of helping people win their cases, and we will do everything in our power to help you avoid a conviction or at least get you a reduced sentence.
Give us a call or fill out our online contact form to schedule a free, no-obligation consultation today. A member of our legal team will review your case and advise you of all your potential options. We will do our best to answer any questions you may have and lay out a plan regarding the best approach to your defense.
Call or text (310) 896-2723 or complete a Free Case Evaluation form