Fraud involves the act of using a deceptive action to take something of value for personal gain or at the detriment of others. Unfortunately, it has many applications throughout the healthcare industry. One of these is Medicaid and Medicare fraud. Through these healthcare programs, millions of Americans obtain much-needed healthcare, so the government maintains harsh punishments for those who have engaged in Medicaid and Medicare fraud. If you are being investigated for such a crime or if charges have already been filed, your next step should be to consult with a healthcare fraud defense attorney.
Understanding Medicaid and Medicare Fraud
Medicaid and Medicare fraud come in a variety of forms. One example is when an individual unlawfully gains access to a victim’s personal identification information or Medicare number to access healthcare benefits. They may obtain personal information online through a phishing scam, over the phone or even by rummaging through the trash.
In other cases, the Medicare or Medicaid patient is the perpetrator. For example, the patient may work together with his or her provider to get reimbursed for fraudulent charges. The pair may have an arrangement for how the benefits will be split. A medical office or practitioner may also engage in fraud without the knowledge of the patient. For example, the provider may bill Medicare or Medicaid for services that were not provided or were not necessary. Even insurance companies can commit Medicaid and Medicare fraud. This may happen if they knowingly use the wrong billing codes or inflate amounts under specific codes with the intention of getting a more favorable Medicaid or Medicare payment.
Penalties for Medicaid and Medicare Fraud
Medicaid and Medicare fraud can impact all parties who use these healthcare programs, so the government takes instances of fraud seriously. These fraudulent acts generally fall under the False Claims Act, and they are punishable by a fine of up to $250,000 and up to life in prison. However, the actual penalties will vary by case based on the Federal Sentencing Guidelines and by the cash value of the actions.
It is important to note that these devastating penalties are not the only consequences of Medicaid and Medicare fraud. For example, if you are a healthcare provider, you may lose your state license to practice, or you may face Medicare program exclusion. You may be required to register appropriately in the National Practitioner Databank, lose assets to seizure, lose insurance billing privileges, lose your DEA privileges and more.
Defense Strategies for Medicaid and Medicare Fraud
Your healthcare fraud defense attorney may be able to structure a plea bargain if he or she is involved early enough in the case. However, a plea bargain may have detrimental ramifications to your professional reputation and your ability to work in your field going forward. With this in mind, your attorney should carefully explain all of your legal options and their impacts before you make a decision.
Prior to reaching the trial stage, your attorney may argue that some of the evidence is inadmissible in court because it was obtained through an illegal search. Another pre-trial argument is that some evidence is privileged and is not subject to search and seizure.
If the matter reaches the courtroom, your attorney must have a detailed defense strategy prepared. Because each Medicare and Medicaid fraud case is unique, multiple strategies may need to be used together. These may be used to argue that fraud has not actually been committed. They may also be used to reduce the value amount of the fraud for lighter sentencing. Another strategy is to call in expert witnesses who can corroborate the medical necessity for certain medical procedures and services.
Talk to a Defense Attorney Today
The impact of a conviction of Medicare or Medicaid fraud can be extensive. Because an effective defense strategy in these types of cases must be tailored to fit the case and requires deep knowledge of the healthcare programs, insurance billing and more, your defense attorney must have detailed expertise in this niche area of the law. If you are facing active or pending charges for Medicaid and Medicare fraud, contact us to schedule a consultation with a healthcare fraud defense attorney today.
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