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Healthcare Fraud

 Healthcare Fraud Defense Attorney

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  Healthcare Fraud Attorney for Doctors

Daniel Horowitz aggressively defends physicians, surgeons, and medical practice owners in Contra Costa County and throughout California against healthcare fraud charges — with a special focus on medical billing fraud, upcoding, unbundling, and False Claims Act investigations.

If you are a doctor under investigation by Medicare, Medicaid, the DOJ, or a California fraud unit, you need an experienced criminal defense specialist who understands both medicine and complex federal billing rules.

WHY DANIEL HOROWITZ IS A DOCTOR'S BEST CHOICE TO DEFEND A HEALTHCARE FRAUD CASE

Daniel Horowitz - One of the Most Experienced Criminal Defense Lawyers 

Daniel Horowitz is an expert medical defense attorney with extraordinary experience representing medical doctors not just in criminal matters but in peer review, medical board actions and license issues.  He brings this experience plus his certification as a criminal defense specialist to his healthcare fraud defense work.  His experience in the criminal field is exceptional.

  • Lead counsel in over 200 criminal jury trials.
  • Law school professor of trial law.
  • Lecturer at criminal defense conferences.
  • Published author on criminal defense.
  • Horowitz’s insightful legal analysis has made him a sought-after commentator in the media including on CNN, MSNBC and Fox News.  Daniel covered the Scott Peterson and Michael Jackson trials for these major networks.   
  • Watch Daniel Horowitz' Commentary on USA TODAY on the Sean “Diddy” Combs Trial
  • U.S. Supreme Court and California Supreme Court admitted.
  •  Legal instructor for courses training attorneys to take the criminal specialist examination.
  • Top 100 Trial Lawyer, Super Lawyer, AVVO, Martindale Hubbell top rated and admitted.
  • Original Contributor to California Criminal Practice & Procedure (CEB Publications)
  • Mentoring: Daniel guides new criminal defense attorneys through the Contra Costa County bar association.
  • Teaching:  Former professor of trial law.

Background and Education:

  • Born in New York City, Horowitz attended Boston University School of Law and then earned his Juris Doctor (J.D.) from Southwestern Law School in Los Angeles, California.  He practiced in Oakland, California (Alameda County) for 26 years and has maintained his office in Lafayette (Contra Costa County) since 2006.
  • He was admitted to the State Bar of California in 1980.
  • Death Penalty Jury Trials (8) in his first 15 years of practice.
  • Major money laundering defense and victory for Ukraine Prime Minister Pavel Lazarenko.
  • Major medical fraud jury trials in state and federal courts.
  • Briefs filed in the United States Supreme Court, California Supreme Court

If you are facing fraud charges call Daniel Horowitz for immediate assistance.  (925) 291-5388

To learn more about Medical (healthcare) Fraud we provide the following additional information.

Medical Billing Fraud Defense for California Doctors

Most physicians we represent did not set out to commit fraud. Many billing fraud cases begin with disagreements regarding billing codes and treatment choices.  Insurance companies use computer algorithms and AI to identify outliers who are then subject to highly biased reviews.  Cases are then pursued civilly and in many cases are also reviewed by insurance company SIU units - to state and federal prosecutors.

KEY AREAS OF COMPUTER & AI AUDITS

  • Upcoding routine visits to higher-level codes
  • Unbundling procedures that should be billed together
  • Improper use of modifiers
  • Billing for services not rendered or not medically necessary
  • Errors caused by billing staff or third-party coders
  • Audits that escalate into criminal investigations

WHY DANIEL HOROWITZ IS THE BEST LAWYER TO DEFEND HEALTHCARE FRAUD CHARGES

As a State Bar of California Board of Legal Specialization Certified Criminal Defense Specialist  Daniel Horowitz is among an elite few attorneys legally permitted to call themselves “CRIMINAL DEFENSE SPECIALIST”.   As a physician you know how important board certification is.  The same in true in criminal law - an expert healthcare defense lawyer is not the same as a criminal defense specialist.  Anyone with a bar card can claim to be an “expert” - the specialist designation is earned by years of experience, judicial and peer recommendations, passing a difficult examination and extended continuing education requirements.

When you life and career are on the line you need Criminal Defense Specialist Daniel Horowitz.

Call Daniel Horowitz at 925-291-5388

 

 

What Doctors Should Do If Facing a Billing Fraud Investigation

Do not speak with investigators without counsel. Many doctors unintentionally harm their defense by trying to “explain” their billing practices.

Our firm provides:

  • Immediate response to subpoenas and search warrants
  • Parallel defense of your medical license
  • Coordination with billing experts and healthcare consultants
  • Negotiation with federal prosecutors and DOJ

Protect your career, license, and freedom. Contact us today for a confidential consultation. innocent conduct may involve criminal consequences.

COMMON MEDICAL FRAUD STATUTES

State prosecutors and the California Attorney General usually prosecute medical fraud using California Penal Code section 550.   To learn more about that section view our PC Section 550 webpage.   The federal statutes usually charged are:

     1. Mail & Wire Fraud

These laws prohibit the use of the mail, internet, phones or other communication mediums to assist in the commission of healthcare fraud (and other crimes).  Read Horowitz' blog on mail and wire fraud.

     2. Federal Stark Law Violations

The Stark Law prohibits physicians from referring Medicare patients for certain designated health services (DHS) to entities with which they or their immediate family members have a financial relationship, unless an exception applies and is met. Financial relationships include ownership, investment interests, and compensation arrangements.

We have blogged extensively on this subject.  See some of our Stark Law Blogs below.

See 

     3. Anti Kickback Statute (AKS) 

The Anti-Kickback Statute (AKS) is a criminal law that can lead to federal prison time. It requires only a low level of criminal intent, meaning you don't need to intend to violate the law to be prosecuted. Simply acting knowingly and intentionally to do something prohibited under the statute is enough.  See Dan Horowitz' blog on the AKS law below.

 Learn About the AKS Law

The AKS prohibits many activities, including paying money or offering something in exchange for patient referrals. It also covers creating business for any item reimbursed by a federal healthcare program. Penalties for AKS violations include prison terms, fines, and exclusion from participating in federal healthcare programs.

     4. The Eliminating Kickbacks in Recovery Act (EKRA):  

EKRA is codified at 18 U.S.C. § 220. The key provisions of EKRA include: 

● Prohibiting the solicitation or receipt of any remuneration in return for referring a patient to a recovery home, clinical treatment facility, or laboratory. 

● Prohibiting the offer or payment of any remuneration to induce such referrals.

The law is focused on people or companies that were getting paid for making referrals to:

● Recovery homes
● Clinical treatment facilities
● Laboratories

     5. 18 USC 1347 the Federal “Catch-All Fraud Statute: 

Billing fraud and more generally health care fraud, is a overly broad area.  There are thousands of pages of rules and regulations and many other relevant statutes. These include 18 USC 1347 (Plain Vanilla Health Care Fraud), 18 USC 1349 (Conspiracy related to Health Care Fraud), 18 USC 1035 (Health Care related false statements) and 18 USC 1956 (money laundering related to health care fraud). 

     6. Beneficiary Inducement Statute (42 U.S.C. § 1320a-7a(a)(5)):

  This statute is a federal law that prohibits offering, paying, soliciting, or receiving any remuneration to induce or reward referrals for services or items reimbursed by federal healthcare programs, such as Medicare and Medicaid. This statute aims to prevent healthcare fraud and abuse by ensuring that medical decisions are based on patient needs rather than financial incentives.  See Daniel's EKRA blog.

What is the "Eliminating Kickbacks in Recovery Act" (EKRA)?

FRAUD TRAP - AVOID THE LENDING YOUR NAME (Video Below)

Private companies led by unscrupulous characters will present seemingly honest business plans to doctors whose only job is supervise a medical spa or radiology lab and in essence lend their name to the business.  This can easily lead to criminal charges.  Watch Daniel's video about this trap (below).

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  • AV Preeminent (Peer Review Rated) by Martindale Hubbell
  • Nation's Top One Percent (NADC)
  • Top 100 Trial Lawyers by The National Trial Lawyers
  • Avvo Rating 10.0 Top Attorney
  • Super Lawyers
  • 5 Star Reviews Avvo
  • United States Court of Appeals Ninth Circuit
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Client Testimonials

    “I won my case and I am very lucky.”
    He is very tough. He made me listen to him and work his way. He was right. It worked. I won my case and I am very lucky.
    Avvo Reviewer
    “What impressed me most was his unwavering dedication to achieving the best possible outcome for me.”
    I cannot express enough gratitude for the outstanding legal services provided by Daniel Horowitz. He not only possesses an in-depth understanding of the law but also demonstrated a genuine commitment to me. He took the time to listen attentively to my concerns, providing clear and concise explanations of the legal processes involved in my case. He made me feel heard and supported during this tumultuous time. What impressed me most was his unwavering dedication to achieving the best possible outcome for me. The attention to detail and strategic approach to my case were evident at every stage. I am eternally grateful towards Daniel for what he has done for me and I wholeheartedly recommend his services to anyone seeking legal representation. Thank you Dan
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    Very caring individual. Daniel handled my divorce back in 1991 and is a very understanding and caring person who took care of my needs with patience and understanding. He is one of a very few of that special breed. Wish to God there were more like him. Thanks, Daniel.
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    My experience with Dan was great. I appreciate the knowledge Dan has and the professionalism they exhibit. I would highly recommend the Law Office Of Daniel Horowitz. My family and I are truly grateful we worked with him.
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