Criminal Defense for California Ophthalmologists

Medical professionals, particularly ophthalmologists, demonstrate an unwavering commitment to preserving and enhancing patient health. However, the complex nature of medical practice can sometimes lead to criminal accusations that threaten both their esteemed professional standing and personal freedom.

We defend Ophthalmologists accused of crimes, such as health insurance fraud, and help them avoid license suspension or revocation.

For ophthalmologists in California, who are working with patients in an inherently vulnerable state, even a misunderstanding can sometimes result in criminal accusations.

An ophthalmologist, as a medical doctor and eye specialist, is responsible for diagnosing and treating all eye diseases and vision problems, from routine eye exams to complex surgeries.

However, due to the nature of their work, they can sometimes face criminal accusations. It's important to remember that early legal intervention can often mitigate these risks, providing a sense of reassurance and proactive management.

After completion of medical school and an eye-specific residency, they can prescribe medication, provide vision correction aids, and perform surgery for conditions like cataracts, glaucoma, and macular degeneration.

They are the only eye-care specialists with the medical and surgical training to perform delicate eye surgeries. Procedures include cataract surgery, corrective laser eye surgery (such as LASIK), and surgery for glaucoma or retinal detachment.

Medical Practice and Criminal Laws

The intersection of medical practice and criminal law presents unique challenges that general attorneys may not fully comprehend.

This is where the expertise of an experienced California criminal defense attorney, who understands both the medical profession and California criminal law, becomes essential when navigating these complex cases.

These attorneys possess the knowledge necessary to evaluate medical procedures, understand industry standards, and effectively challenge accusations that could otherwise devastate a medical career.

They can review medical records to identify errors, consult with expert witnesses to refute allegations, and negotiate with prosecutors to reduce charges or penalties.

Their role is not just to defend against the charges, but also to protect the professional reputation and future career prospects of the ophthalmologist.

Examples of Criminal Charges Against Ophthalmologists

Ophthalmologists may face a variety of criminal charges related to their practice, each carrying serious legal implications under California law. Here are just a few examples, along with a brief explanation of their legal implications:

Healthcare Fraud and Insurance Fraud: Under California Penal Code Section 550, insurance fraud encompasses submitting false claims, billing for services not rendered, or misrepresenting procedures to insurance companies. Examples that might raise red flags include charging for diagnostic tests that are not medically necessary, billing for comprehensive eye exams that were never conducted, and over-coding to receive higher reimbursement. Even honest mistakes in coding can trigger audits or investigations.
Prescription Drug Violations can occur when ophthalmologists prescribe controlled substances inappropriately--for example, prescribing medications without a valid medical reason, overprescribing certain medicines, etc. California Health and Safety Code Section 11153 governs prescription practices, while violations of the Controlled Substances Act under federal law can result in both state and federal charges.
Sexual Battery and Sexual Assault charges under California Penal Code Section 243.4 may arise from allegations of inappropriate conduct during patient examinations. These accusations can stem from misunderstandings during routine procedures or more serious misconduct allegations.
Patient Abuse charges under California Penal Code Section 368 may apply when elderly or dependent patients are involved. These cases often involve allegations of neglect or improper treatment that causes harm to vulnerable patients.
Forgery/Falsifying Medical Records: Penal Code Section 470 makes it a crime to forge signatures or falsify official documents, including medical records, prescriptions, or consent forms. Penal Code 471.5 specifically addresses creating or altering medical records with fraudulent intent.
Unlicensed Practice or Aiding It: Under Business & Professions Code 2052, it is a felony to practice medicine without a license, or to allow another person to do so knowingly. Ophthalmologists can face charges if they delegate medical tasks to unqualified or uncertified staff. Examples include allowing medical assistants to perform laser treatments, signing off on procedures they didn't oversee, and employing foreign-licensed doctors who are not licensed in California

What Does PC 550 Say?

As noted above, Insurance fraud is covered by California Penal Code 550 PC, which says, "(a) It is unlawful to do any of the following, or to aid, abet, solicit, or conspire with any person to do any of the following:

(1) Knowingly present or cause to be presented any false or fraudulent claim for the payment of a loss or injury, including payment of a loss or injury under a contract of insurance.

(2) Knowingly present multiple claims for the same loss or injury, including presentation of multiple claims to more than one insurer, with an intent to defraud.

(5) Knowingly prepare, make, or subscribe to any writing, with the intent to present or use it, or to allow it to be presented, in support of any false or fraudulent claim.

(6) Knowingly make or cause to be made any false or fraudulent claim for payment of a health care benefit.

(7) Knowingly submit a claim for a health care benefit that was not used by, or on behalf of, the claimant.

(8) Knowingly present multiple claims for payment of the same health care benefit with an intent to defraud.

(9) Knowingly present for payment any undercharges for health care benefits on behalf of a specific claimant unless any known overcharges for health care benefits for that claimant are presented for reconciliation at that same time.

(10) For purposes of paragraphs (6) to (9), inclusive, a claim or a claim for payment of a health care benefit also means a claim or claim for payment submitted by or on behalf of a provider of any workers' compensation health benefits under the Labor Code."

Involuntary Manslaughter

This includes rare cases where gross negligence leads to death, as defined under Penal Code 192(b). While not common among ophthalmologists, criminal charges can arise when patient harm results from severe medical negligence.

Involuntary manslaughter is an unintentional killing resulting from recklessness or gross negligence.

Some examples include failing to monitor a patient after eye surgery, leading to infection and death, and ignoring severe complications like glaucoma-related pressure, and proceeding with a risky procedure despite clear contraindications.

Possible Consequences of Conviction

Criminal convictions for ophthalmologists carry severe consequences that extend far beyond traditional criminal penalties. If you're an ophthalmologist convicted of a crime in California, you could face:

Criminal Penalties: Depending on the charge, these can include substantial prison sentences, significant fines, and restitution payments to alleged victims. Felony convictions can result in years of imprisonment, while misdemeanor convictions may involve county jail time and probation.
Professional License Consequences often prove more devastating than criminal penalties. The Medical Board of California can suspend or revoke a medical license based on a criminal conviction. Even arrests without convictions can trigger disciplinary proceedings that threaten professional standing.
Hospital Privileges and Medical Staff Appointments face immediate jeopardy following criminal charges. Hospitals typically suspend privileges pending resolution of criminal cases, effectively preventing practice continuation during lengthy legal proceedings.
Insurance and Malpractice Coverage complications arise when carriers exclude coverage for criminal acts or cancel policies following charges. This leaves ophthalmologists financially vulnerable during critical periods.
Professional Reputation and Practice Viability: You could suffer irreparable damage from public criminal allegations. Patient trust, referral relationships, and practice value all decline significantly when criminal charges become public knowledge.
Federal Exclusion from Healthcare Programs can result from certain convictions, permanently barring participation in Medicare, Medicaid, and other federal healthcare programs under the authority of the Office of Inspector General.

How a Criminal Defense Attorney Can Help

Due to the more complex nature of criminal allegations against licensed professionals like ophthalmologists, your best hope for a positive outcome lies with hiring a skilled California criminal defense attorney with specific experience in such cases. Some examples of the advantages of working with a good attorney:

Early Intervention and Investigation: A good attorney will work to preserve evidence, interview witnesses, and develop defense strategies before charges are formally filed. This proactive approach often prevents charges or reduces their severity.
Medical Expert Consultation: Your attorney will work with other qualified medical professionals who can evaluate procedures, review medical records, and provide expert testimony regarding standard of care issues. These experts help attorneys understand complex medical procedures and identify potential defenses.
Regulatory Knowledge allows a good attorney to navigate both criminal courts and medical board proceedings simultaneously. This dual experience proves crucial when criminal charges trigger professional licensing investigations.
Plea Negotiation and Alternative Sentencing options may include diversionary programs, reduced charges, or sentences that minimize professional consequences. Experienced attorneys understand which alternatives prosecutors might accept and how to structure agreements that protect medical careers.

For more information, contact our criminal defense law firm, Eisner Gorin LLP, located in Los Angeles, CA.

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