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Charged with or Under Investigation for Hospice Fraud in California?

Federal and State Prosecutors Are Aggressively Targeting Hospice Providers — Allegations of Ineligible Patients, Kickbacks, and False Claims Can Lead to Years in Federal Prison, Massive Restitution, License Revocation, and Permanent Exclusion from Medicare and Medi-Cal.

California criminal defense attorney David Chesley has successfully defended hospice fraud investigations and charges — including federal healthcare fraud (18 U.S.C. § 1347), False Claims Act violations, Anti-Kickback Statute matters, and related Medi-Cal fraud allegations — in federal and state courts across every county in California. These complex cases often involve parallel criminal, civil, and administrative proceedings. Early intervention during the investigation phase is critical. Build your defense now.

IMMEDIATE STEPS IF UNDER INVESTIGATION OR CHARGED:

• Do not speak with FBI, HHS-OIG, DOJ, or state investigators without counsel — questions are specifically designed to elicit statements establishing knowledge or intent; in hospice fraud cases, what you say about your billing practices, your awareness of patient eligibility, and your understanding of certifications is the prosecution's most important evidence
• Do not destroy, alter, or delete any records, charts, billing data, or communications — document destruction after a government investigation begins constitutes obstruction of justice and carries its own federal felony exposure entirely independent of the underlying fraud allegations
• Preserve all documentation — patient records, physician certifications, clinical notes, billing submissions, marketing agreements, compliance materials, and all communications between staff, billing departments, and referral sources
• Contact experienced federal healthcare fraud counsel immediately — the investigation phase is when the government builds its case; early defense can prevent charges from being filed, limit the scope of the government's theory, and protect individual defendants before cooperating witnesses have given their accounts

Call now for a free, confidential consultation — available 24/7. 📞 (800) 755-5174

THE STAKES ARE REAL

Hospice fraud is a high-priority federal enforcement target in California. Recent investigations and prosecutions have focused on ineligible patient enrollment, kickback arrangements, upcoding, and falsified documentation — often resulting in multi-million-dollar loss calculations that drive federal sentencing guidelines ranges into years and decades of prison exposure. The federal government pursues these cases with specialist prosecutors, specialist investigators, and the full resources of the federal grand jury system — building cases over years before a single charge is filed.

A conviction can mean:

• Federal prison: Up to 10 years per count under 18 U.S.C. § 1347 — 20 years or more per count if serious bodily injury results; up to life imprisonment if death results
• Massive restitution and fines — full restitution to Medicare, Medi-Cal, and all affected government payers for every dollar of fraudulent billing, often totaling millions
• Treble damages under the False Claims Act — civil liability of three times the fraudulent billing amount plus per-claim penalties, running independently of the criminal case
• Permanent exclusion from Medicare and Medi-Cal — effectively ending the ability to operate in or be employed by any entity serving federal healthcare program patients
• License revocation — for physicians, nurses, and all licensed healthcare professionals; mandatory reporting triggers board proceedings
• Asset forfeiture — all proceeds traceable to the fraudulent billing scheme, including business and personal assets

Common Hospice Fraud Allegations vs. Strong Defenses:

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WHAT IS HOSPICE FRAUD?

Hospice fraud generally involves submitting false or misleading claims to Medicare or Medi-Cal for hospice services. The government alleges violations of:

• 18 U.S.C. § 1347 — Federal healthcare fraud: knowingly executing a scheme to defraud a healthcare benefit program
• Anti-Kickback Statute (42 U.S.C. § 1320a-7b) — Prohibiting knowing and willful payment or receipt of remuneration to induce or reward referrals of Medicare or Medi-Cal patients
• False Claims Act (31 U.S.C. § 3729) — Civil and criminal liability for knowingly submitting false claims to the federal government
• California Penal Code § 550 — State insurance fraud, frequently charged alongside federal counts in California hospice prosecutions

The prosecution must prove knowing submission of false claims — not honest billing errors or good-faith clinical disagreements. That distinction is the foundation of every hospice fraud defense.

Key Defenses in Hospice Fraud Cases:

Lack of intent / good faith

Honest clinical judgment, reliance on physician certifications, and legitimate billing practices do not equal fraud. The prosecution must prove the defendant knew the claims were false — not that billing decisions were later characterized as incorrect by a government reviewer applying hindsight.

Insufficient evidence of ineligibility

Challenging whether patients were truly ineligible at the time of certification — through contemporaneous clinical records, treating physician testimony, and independent expert analysis of the patient's prognosis at the time certifications were made.

Anti-Kickback safe harbors

Legitimate compensation arrangements — bona fide employment arrangements, personal services arrangements meeting regulatory requirements, and other structures falling within established safe harbors — do not violate the AKS regardless of the government's characterization.

Reliance on experts and compliance systems

Following the advice of compliance officers, billing specialists, or regulatory counsel — and implementing compliance programs designed to ensure accurate billing — defeats the knowing and willful element the prosecution must prove.

Loss amount challenges

Forensic billing analysis frequently demonstrates that the government's loss calculation is significantly overstated — including patients who were legitimately eligible, failing to account for legitimate reimbursement, or using flawed statistical sampling. Reducing the loss amount reduces the sentencing guidelines range, often by years.

WHO CAN BE CHARGED — INDIVIDUAL LIABILITY IN HOSPICE FRAUD CASES

Federal hospice fraud prosecutions do not stop at the organizational level. Individual criminal charges are filed against defendants at every level of the hospice operation — and understanding what the government must prove for each role, and what defenses are available based on that specific role, is one of the most important early tasks in every hospice fraud defense.

Physicians and Nurse Practitioners

Charged when the government alleges they signed eligibility certifications without adequate clinical basis or conducted face-to-face encounters producing inaccurate documentation. The critical defense for physicians and NPs is that the certification reflected genuine clinical judgment supported by the patient's contemporaneous medical record — not a fabricated or commercially driven assessment. Prognosis is not a precise science. A physician who certified a patient as terminally ill based on their honest assessment of the patient's disease trajectory, even if the patient later lived beyond the six-month prognosis, did not commit fraud. The government's retrospective billing data analysis does not establish that certifications were fraudulent at the time they were made — and that distinction is the most important battleground in physician-level hospice fraud cases.

Clinical Directors and Directors of Nursing

Charged based on supervisory responsibility for the clinical staff whose assessments form the basis for billing. The knowledge element for supervisory defendants requires proof that they were aware of inaccurate assessments or falsified documentation — not merely that it occurred on their watch. A clinical director who implemented proper protocols, supervised assessments in good faith, and had no actual knowledge of systematic falsification does not meet the knowledge standard the government must prove.

Billing Managers and Billing Coordinators

Charged when the government alleges they submitted claims they knew or should have known were not supported by the clinical record. The knowledge element for billing staff is the most important and most frequently successful defense target for this category: a billing coordinator who submitted claims based on documentation provided by clinical staff, who had no independent ability to assess patient eligibility, and who had no actual knowledge that the underlying certifications were inaccurate did not act with the knowing and willful intent required for federal healthcare fraud. The reliance-on-others defense — that the billing staff relied on the clinical determinations of licensed professionals and had no basis to question them — is the most important defense for billing-level defendants.

Owners and Executives

Charged based on their establishment of the business model, compensation structures, and operational policies that the government alleges produced fraudulent billing. Individual knowledge is required — general awareness of billing practices is not sufficient. Executives who implemented compliance programs, relied on advice of counsel or compliance officers, and had no specific knowledge that individual certifications or claims were false have specific defenses that must be developed from the first day of representation.

Marketing Staff

Charged in kickback cases based on their role in recruiting patients through alleged remuneration arrangements. The knowledge and willful element — that the marketing employee knew the compensation arrangement violated the Anti-Kickback Statute — is the most important defense target, and marketing staff who implemented arrangements they were told were legally compliant have specific reliance defenses that distinguish their exposure from that of the principals who designed the arrangements.

The Most Important Principle for All Individual Defendants

Individual criminal liability requires proof that the specific defendant acted with knowledge that the claims were false or with deliberate indifference to their falsity — not proof that false claims were submitted somewhere in the organization. Every individual defendant's specific role, specific knowledge, and specific conduct is analyzed independently — and the government's burden to prove each element as to each defendant individually is the foundation of every individual liability defense.

HOW DAVID CHESLEY DEFENDS HOSPICE FRAUD CASES

These cases require simultaneous defense on criminal, civil False Claims Act, and administrative exclusion tracks — while protecting individual defendants from organizational liability, managing coordinated defense of multiple defendants, and ensuring the government's characterization of clinical decisions as fraud is contested at every level. David Chesley personally handles every hospice fraud case statewide — Southern, Central, and Northern California, every county, every major federal district — and is available 24 hours a day, 7 days a week. No hand-offs. No junior associates. The attorney you hire is the attorney fighting for you.

Core defense strategies pursued immediately:

Investigation-phase intervention

The most important defense work in any federal healthcare fraud case happens before charges are filed. Grand jury subpoena responses, employee interview coordination, joint defense arrangements, and presentation of exculpatory clinical evidence to prosecutors before the charging theory is locked in — all pursued immediately upon retention.

Challenging the government's clinical theory

The government's retrospective billing analysis is challenged through contemporaneous clinical records, treating physician testimony, and independent expert review establishing that certifications reflected genuine clinical judgment at the time they were made.

Individual knowledge element defense

Each defendant's specific role, actual knowledge, and specific conduct is analyzed to determine whether the government can establish the required knowledge or deliberate indifference element — because individual liability requires more than organizational proximity to fraud.

Loss amount challenge

Independent forensic billing analysis examines the government's methodology, identifies patients with legitimate clinical eligibility incorrectly included in the loss calculation, and challenges overstated figures that are inflating the guideline range.

Anti-Kickback safe harbor analysis

Every compensation arrangement alleged as a kickback is analyzed against the AKS safe harbor framework to determine whether a legitimate structural defense exists.

Civil FCA and administrative track management

Civil False Claims Act exposure and Medicare exclusion proceedings are addressed simultaneously with the criminal defense — because decisions made in one proceeding directly affect the others.

Free, confidential case review — available 24/7, no obligation. 📞 (800) 755-5174 | 📧 calllog@chesleylawyers.com

YOU HAVE RIGHTS. USE THEM.

The government must prove knowing submission of false claims — not good-faith decisions, clinical judgment disagreements, or honest billing errors. Federal investigations are aggressive, but they are not infallible, and many hospice fraud cases resolve significantly better than defendants initially face:

• Investigation closed without charges — early intervention presents exculpatory clinical evidence; government declines to charge
• Individual charges defeated — knowledge element not established; defendant's role insufficient for criminal liability
• Clinical certifications defended — contemporaneous records and expert testimony establish good-faith judgment
• Loss amount successfully reduced — forensic analysis demonstrates government's calculation is overstated; guideline range reduced by years
• Kickback allegations defeated — compensation arrangements fall within AKS safe harbors
• Civil FCA exposure negotiated — civil settlement preserves defenses in the criminal case
• Exclusion avoided or minimized — resolution structured to limit Medicare and Medi-Cal exclusion consequences
• License consequences minimized — resolution structured to reduce mandatory reporting and board exposure

WHY CLIENTS CHOOSE DAVID CHESLEY

Direct, personal attention — statewide, 24/7

David Chesley personally handles hospice fraud defense in federal courts and California courts across all of California — Los Angeles, San Diego, Orange County, San Francisco, Sacramento, Fresno, San Jose, Riverside, San Bernardino, Ventura, and every other jurisdiction statewide. Available 24 hours a day, 7 days a week — because federal agents appear unannounced and the window to respond effectively to initial government contact is measured in minutes, not days.

Straight talk, always

Hospice fraud cases range from situations where the government's clinical theory is legally defective, the individual defendant's knowledge cannot be established, or the loss amount is substantially overstated — to cases where the evidence is substantial and the focus shifts to minimizing guidelines exposure, negotiating cooperation, or resolving the case to preserve the ability to continue practicing. You deserve honest counsel about which situation you are actually in. No false promises. No sugarcoating.

Multi-track strategy addressing criminal, civil, and administrative exposure

The criminal case, the civil FCA track, and the Medicare exclusion proceedings all begin simultaneously and require simultaneous defense. David Chesley manages every track from the first day of representation — ensuring no front is left undefended and that positions taken in one proceeding do not create additional exposure in another.

Federal healthcare fraud expertise — clinical, regulatory, and legal

Deep knowledge of the federal Medicare hospice benefit regulatory framework, eligibility certification requirements, the Anti-Kickback Statute and safe harbors, the False Claims Act and qui tam provisions, federal healthcare fraud sentencing guidelines loss amount calculations, HHS-OIG investigation methodology, and the specific clinical and billing issues that define every hospice fraud prosecution — across every region of California.

Flexible payment plans

The Law Offices of David Chesley offer flexible payment plans because cost should never be the reason someone under investigation for hospice fraud goes without experienced representation during the phase when it matters most.

Representative Results:

• Federal investigation closed without charges — investigation-phase intervention presented clinical documentation and expert analysis establishing certifications were supported by contemporaneous patient records; government declined to charge
• Physician avoided charges and license revocation — strong medical necessity and good-faith clinical judgment defense established; clinical expert testimony contradicted government's retrospective analysis; case resolved favorably
• Loss amount significantly reduced — forensic billing analysis demonstrated government's calculation included patients with legitimate clinical eligibility; revised amount reduced guideline range by multiple levels; sentence reduced significantly
• Individual billing coordinator charges dismissed — knowledge element not established; defendant relied on clinical staff determinations and had no basis to question certifications; government could not prove knowing submission of false claims
• Kickback allegation defeated — medical director compensation arrangement found to fall within AKS personal services safe harbor; Anti-Kickback charge not sustained
• Civil FCA exposure negotiated — civil settlement achieved that resolved government's False Claims Act claims while preserving key defenses in the parallel criminal proceedings

Client Feedback:

"Federal agents showed up at my hospice unannounced. I called David immediately. He managed every aspect of the investigation response, coordinated with our staff, and prevented charges from being filed. Having counsel immediately was the difference." — Anonymous hospice administrator

"As a physician, I faced serious allegations over certifications I made in good faith based on my clinical assessment. David brought in clinical experts, established that my judgment was supported by the contemporaneous records, and the charges were resolved favorably." — Anonymous physician

"The loss amount the government was using would have meant years in federal prison. David's forensic accounting analysis showed they were significantly overstating it. The reduction in the guideline range changed everything." — Anonymous former client

"Non-citizen healthcare administrator. David knew immediately that a federal conviction meant deportation and built the entire defense around avoiding that outcome. Resolved without a conviction." — Anonymous former client

FREQUENTLY ASKED QUESTIONS

What should I do if contacted by federal agents?

Do not speak with them or produce any documents without experienced defense counsel present. Federal agents conducting hospice fraud investigations are trained interviewers who ask questions specifically designed to elicit statements establishing knowledge, intent, or awareness of billing irregularities — and statements made without counsel present are among the most damaging evidence in federal healthcare fraud prosecutions. Call experienced counsel immediately — before responding to any agent contact, before producing any documents, and before discussing the investigation with anyone inside or outside the organization.

Can I be charged even if I didn't personally submit the claims?

Yes — and this is one of the most frightening aspects of federal hospice fraud prosecutions. The government charges individuals based on their role in the organization and their actual or constructive knowledge of the fraudulent billing — not based solely on whether they personally pressed submit on a claim. But individual criminal liability requires proof that the specific defendant acted with knowledge that the claims were false or with deliberate indifference to their falsity. A physician who made certifications based on genuine clinical judgment, a billing coordinator who submitted claims relying on clinical documentation she had no reason to question, and an administrator who implemented policies without specific knowledge of their fraudulent character each have specific defenses based on their individual role and individual knowledge — and those defenses must be developed and presented from the very first day of representation.

What is the False Claims Act — and how does it affect my case?

The False Claims Act (31 U.S.C. § 3729) creates civil liability for submitting false or fraudulent claims to the federal government — and in hospice fraud cases, it produces civil exposure that frequently dwarfs the criminal penalties. The FCA allows the government to recover treble damages — three times the total amount of the false claims — plus per-claim civil penalties of $13,000 to $27,000 for each individual false claim submitted. A hospice that submitted billing for thousands of ineligible patients over several years can face civil FCA liability measured in hundreds of millions of dollars, entirely independent of and in addition to the criminal case. The FCA also contains a qui tam provision that allows private whistleblowers — including former employees, disgruntled staff, or competitors with inside knowledge — to file FCA lawsuits on behalf of the government and share in any recovery, sometimes triggering the government investigation in the first place. The civil FCA track runs simultaneously with the criminal case, and the interaction between the two — how a civil resolution affects the criminal case, whether civil cooperation benefits the criminal defense, and how to manage both tracks without creating additional exposure in either — is one of the most important strategic questions in every hospice fraud defense, analyzed from the first consultation.

How do federal sentencing guidelines work in hospice fraud cases — and why does the loss amount matter so much?

Federal sentencing guidelines for healthcare fraud cases use the "loss amount" — the total value of the fraudulent billing alleged — as the primary driver of the sentencing range. The guidelines assign increasing offense level additions for larger loss amounts: losses over $150,000 add multiple levels; losses over $1.5 million add more; losses over $3.5 million add more still; and losses in the tens or hundreds of millions add levels that produce sentencing ranges measured in decades. Every additional offense level in the guidelines adds months or years to the recommended sentence — and the difference between one loss tier and the next can mean the difference between a sentence of 2 years and one of 8 years. This is why challenging the government's loss calculation is one of the most important and most frequently successful strategies in every hospice fraud case where enhancements are alleged. Government loss calculations in hospice fraud cases are frequently overstated — including patients who were legitimately eligible and whose billing should not be counted as fraudulent loss, failing to account for legitimate reimbursement amounts that offset the loss, and using statistical extrapolation methodologies that inflate the fraud rate beyond what the actual clinical records support. An independent forensic billing analysis that reduces the loss amount from one guidelines tier to another can reduce the sentencing recommendation by years — and in cases involving very large alleged losses, by a decade or more. This analysis is pursued in every hospice fraud case from the first day of representation.

What is the Anti-Kickback Statute — and what are the safe harbors?

The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) prohibits the knowing and willful payment or receipt of remuneration to induce or reward referrals of patients covered by Medicare or Medi-Cal. In hospice cases, the most common AKS allegations involve medical director fee arrangements alleged to be remuneration for referrals rather than legitimate compensation for services, facility staff payment arrangements providing services to nursing home staff in exchange for referral access, and marketing arrangements involving gifts or other benefits to referral sources. AKS violations require knowing and willful conduct — a specific corrupt intent that must be proven beyond a reasonable doubt. The statute provides safe harbors for bona fide employment arrangements, personal services arrangements meeting specific criteria, and other legitimate compensation structures — and arrangements falling within a safe harbor do not violate the AKS regardless of the government's characterization. Every compensation arrangement alleged as a kickback is analyzed against the safe harbor framework to determine whether a legitimate defense exists.

What is Medicare exclusion — and how serious is it?

Exclusion from Medicare and Medi-Cal means the individual or organization is prohibited from participating in federal healthcare programs — treating Medicare or Medi-Cal patients, billing those programs, or being employed by any entity that bills them. For healthcare professionals, exclusion effectively ends the ability to practice in any setting serving federal healthcare program patients — which is the overwhelming majority of clinical settings in California. Mandatory exclusion applies automatically upon conviction for certain healthcare fraud offenses. Minimizing or avoiding exclusion through the structure of the resolution is a critical component of every hospice fraud defense strategy.

Will a conviction affect my medical or professional license?

A federal healthcare fraud conviction triggers mandatory reporting to the California Medical Board, Board of Registered Nursing, or other relevant licensing board — and creates substantial risk of license revocation or suspension for most licensed healthcare professionals. The licensing consequences are analyzed from the first consultation in every hospice fraud case involving licensed professionals, and the resolution strategy accounts for those consequences explicitly at every step.

Can a conviction affect my immigration status?

Seriously and potentially permanently. Federal healthcare fraud convictions are crimes of moral turpitude and potentially aggravated felonies under federal immigration law — triggering mandatory deportation, detention, removal, and permanent bars to naturalization for non-U.S. citizens. For any non-U.S. citizen under investigation for or charged with hospice fraud, immigration consequences must be analyzed from the very first consultation.

Are payment plans available?

Yes. The Law Offices of David Chesley offers flexible payment plans because cost should never be the reason someone under investigation for or charged with hospice fraud goes without experienced legal representation during the phase of the case when counsel matters most. Call to discuss options during your free consultation.

More questions? We are available 24/7 — free consultation, no obligation, no pressure. 📞 (800) 755-5174

FREE CONSULTATION — CALL NOW — 24/7

Hospice fraud investigations move quickly and involve multiple agencies — and every day without experienced defense counsel is a day the investigation advances without anyone protecting the defendant's rights or presenting the exculpatory evidence that might prevent charges from being filed. Every day employees are approached, interviewed, and questioned without coordinated defense guidance is a day statements are made — by clinical staff, billing coordinators, marketing employees, and others inside the organization — that will be used to build the case against individual defendants who had no idea those conversations were happening or what was being said. Every day the government's loss calculation sits unchallenged in the investigation file is a day the overstated figure that may be inflating the guideline range by years becomes more embedded in the prosecution's theory — and the forensic billing analysis that could challenge it and reduce it becomes harder to conduct as records age and the government's narrative about the total harm calcifies. And every day a qui tam whistleblower lawsuit moves forward without a defense attorney coordinating the civil and criminal response is a day the civil and criminal tracks develop in ways that may conflict with each other and create additional exposure in both.

Don't wait for charges to be filed. Don't assume the investigation will resolve itself. And don't speak to federal agents without experienced counsel. If you have received a subpoena, if federal agents have appeared at your hospice or your home, if you have been contacted by the FBI or HHS-OIG, if a former employee has filed a qui tam lawsuit, or if you have been formally charged, call now.

The Law Offices of David Chesley offer a free, confidential consultation available 24 hours a day, 7 days a week. No judgment. No pressure. Clear, honest guidance on your specific situation across every track — criminal, civil, and administrative.

Flexible payment plans available.

David Chesley handles hospice fraud defense in federal courts and criminal courts across all of California — Los Angeles County, Orange County, San Diego County, Riverside County, San Bernardino County, Ventura County, Santa Barbara County, Kern County, Fresno County, Sacramento County, Alameda County, Santa Clara County, San Francisco County, Contra Costa County, San Joaquin County, Stanislaus County, Monterey County, and every other jurisdiction statewide.

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"Hospice fraud cases are complex matters involving clinical judgment, regulatory compliance, and federal sentencing guidelines. The government must prove knowing falsehoods — not good-faith decisions or honest billing errors. My commitment is to defend every element aggressively on every track — criminal, civil, and administrative — while protecting your freedom, license, and future." — David Chesley, California Criminal Defense Attorney