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The Spodek Law Group understands how delicate high-profile cases can be, and has a strong track record of getting positive outcomes. Our lawyers service a clientele that is nationwide. With offices in both LA and NYC, and cases all across the country - Spodek Law Group is a top tier law firm.

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The reason is simple: clients want white glove service, and lawyers who can win. Every single client who works with the Spodek Law Group is aware that the attorney they hire could drastically change the outcome of their case. Hiring the Spodek Law Group means you’re taking your future seriously. Our lawyers handle cases nationwide, ranging from NYC to LA. Our philosophy is fair and simple: our nyc criminal lawyers only take on clients who we know will benefit from our services.

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Medicaid Fraud Defense Attorneys

By Spodek Law Group | October 18, 2023
(Last Updated On: October 19, 2023)

Last Updated on: 19th October 2023, 02:18 pm


Medicaid Fraud Defense Attorneys

Dealing with accusations of Medicaid fraud can be scary. The government has tons of resources to investigate and prosecute fraud cases, so it can feel like the deck is stacked against you. That’s why having an experienced Medicaid fraud defense attorney on your side is so important.

Let’s break down what Medicaid fraud is, what the consequences can be if convicted, and how a knowledgeable lawyer can defend you.

What is Medicaid Fraud?

Medicaid fraud refers to intentionally deceiving the Medicaid program to receive benefits or payments you aren’t entitled to. There are lots of ways fraud can occur, including:

  • Billing for services that were never provided
  • Billing for unnecessary services
  • Billing for services at a higher rate than is allowed
  • Billing multiple times for the same service
  • Falsifying diagnoses to justify services
  • Accepting kickbacks for referrals of Medicaid patients

Prosecutors take Medicaid fraud very seriously because it steals money from an important government program. But not every billing error is fraud – sometimes mistakes happen or the rules can be unclear.

Penalties for Medicaid Fraud

A Medicaid fraud conviction carries stiff penalties like:

  • Up to 10 years in prison
  • Large fines up to $250,000 per fraudulent act
  • Having to repay 3 times the amount of money involved
  • Loss of medical license
  • Exclusion from Medicaid and Medicare

These penalties can destroy a medical career and financial future, so fighting the charges is critical.

How Can a Lawyer Defend Against Fraud Charges?

An experienced Medicaid fraud attorney knows how to pick apart the government’s case and raise reasonable doubt. Here are some of the ways they defend clients:

  • Question the evidence – Prosecutors often rely heavily on medical records and billing records. But a skilled lawyer can scrutinize the records to identify inconsistencies, errors, and lack of hard evidence of intent to defraud.
  • Challenge the witnesses – Doctors, nurses, office staff, and even patients may testify against you. But your attorney can expose contradictions, lapses in memory, biases, and credibility problems in their testimony.
  • Show you acted in “good faith” – Perhaps you made billing errors but had no intent to defraud. Demonstrating you acted in good faith and did not willfully violate the law is a strong defense. An attorney can gather evidence and testimony to prove your good intentions.
  • Prove lack of knowledge – In some cases, employees commit fraud without the doctors’ knowledge. Your lawyer can work to show you were unaware of unlawful conduct within your practice.
  • Negotiate alternate resolutions – Many fraud cases get resolved through settlements or pretrial diversion programs that avoid criminal charges. An attorney may negotiate deals like returning overpayments or compliance plans.

There are many other defenses a knowledgeable lawyer might raise based on the specifics of your case. Having an attorney who specializes in Medicaid fraud is key.

Finding the Right Medicaid Fraud Defense Attorney

Don’t leave your defense in the hands of just any lawyer. Look for an attorney with specific experience defending Medicaid fraud cases, such as:

  • A proven track record handling these complex cases
  • Knowledge of Medicaid billing rules and procedures
  • Relationships with prosecutors and regulators
  • Experience negotiating favorable settlements
  • A reputation for aggressively defending clients

It also helps to find a lawyer familiar with your local federal prosecutors. And look for someone you feel comfortable with and can trust to fight for you.

Being charged with Medicaid fraud feels overwhelming. But the right attorney levels the playing field and gives you the best chance at a favorable outcome. Don’t go it alone against the government – get an experienced lawyer on your side.

Fighting Fraud Charges in Court

If negotiating a settlement isn’t possible, your case may end up at trial. Your Medicaid fraud defense attorney will fight to get charges dismissed or win a not guilty verdict in court. Here’s how they’ll defend you:

  • File motions to suppress evidence – If evidence was obtained illegally, your attorney can seek to get it excluded from the trial. This puts more pressure on prosecutors.
  • Cross-examine witnesses – Your lawyer will aggressively question prosecution witnesses about inconsistencies and credibility problems in their accounts.
  • Object to evidence – Attorneys object during trial to improper questions and inadmissible evidence prosecutors introduce.
  • Present defense evidence – Your lawyer may call expert witnesses to rebut the prosecution’s arguments and make the case for your innocence.
  • Raise reasonable doubt – By picking apart the prosecution’s case, your attorney only needs to raise reasonable doubt about your guilt to win.

An adept trial lawyer knows how to attack weak spots in the prosecution’s case and tell your side of the story effectively. And they aren’t afraid to take on the government and aggressively defend your rights in court.

Avoiding Fraud Charges in the First Place

They say “an ounce of prevention is worth a pound of cure.” Here are some tips to avoid Medicaid fraud allegations:

  • Carefully review billing rules and updates so you don’t make errors
  • Audit your records periodically to identify and correct any issues
  • Watch for red flags like requests for kickbacks or falsified diagnoses
  • Hire experienced medical billing staff and train them diligently
  • Implement a compliance program to prevent and detect problems
  • Seek guidance from regulators if you have questions

But if you do end up facing fraud allegations, turn to an experienced Medicaid fraud defense attorney. With an aggressive lawyer on your side, you can avoid harsh penalties and save your reputation.

Key Laws on Medicaid Fraud

There are a few key laws that form the basis for most Medicaid fraud prosecutions:

  • Federal False Claims Act – This law makes it illegal to knowingly submit false claims for payment to the government, which includes Medicaid. Violations are punishable by fines of $5,500-$11,000 per false claim, plus triple damages.
  • Anti-Kickback Statute – This law prohibits offering, paying, soliciting, or receiving kickbacks to induce referrals of Medicaid patients. Violations are felonies punishable by fines up to $25,000 and 5 years in prison.
  • Stark Law – This civil law essentially prohibits doctors from referring Medicaid patients to medical facilities in which they have a financial interest. Violations result in denial of payment.

There are also many state laws prohibiting Medicaid fraud. A skilled attorney will have expertise in the relevant federal and state laws.

Precedent Medicaid Fraud Cases

Looking at how courts have ruled in past Medicaid fraud cases can provide insight into how your case may play out. Here are two notable precedents:

  • U.S. vs. Larm – In this case, a doctor was charged for getting kickbacks for Medicaid referrals but argued he didn’t know the payments were illegal. The court still found him guilty, ruling ignorance of the law is not a defense.
  • U.S. vs. Lorenzo – Here, prosecutors had evidence of billing errors but no proof the doctor knew the claims were false. The court ruled that intent to defraud is necessary for conviction.

Experienced attorneys are familiar with key cases like these and can argue how precedents support dismissal or acquittal in your case.

Finding an Attorney You Can Trust

Facing Medicaid fraud charges, you need someone in your corner you can trust completely. Look for these qualities in a defense lawyer:

  • Will be honest and upfront about your options
  • Takes time to understand your side and goals
  • Responds quickly and keeps you informed
  • Has a confident but compassionate style
  • Is passionate about defending you

Having an attorney who hears you, understands the stakes, and will fight tirelessly for you makes all the difference. Don’t settle for less than the best counsel.

The Bottom Line

Medicaid fraud allegations can be scary. But an experienced defense attorney can stand up to the government and protect your rights. Don’t take chances with your career and reputation. Get knowledgeable legal help fighting fraud charges and safeguard your future.


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