Last Updated on: 19th October 2023, 01:13 pm

Medicaid Fraud Defense Attorneys

Dealing with accusations of Medicaid fraud can be scary. You may be worried about possible criminal charges, fines, or being excluded from participating in Medicaid programs. That’s why it’s important to have an experienced Medicaid fraud defense attorney on your side. In this article, we’ll walk through what Medicaid fraud is, typical penalties, and how a knowledgeable lawyer can defend you.

What is Medicaid Fraud?

Medicaid fraud refers to intentionally deceiving or misrepresenting information to the Medicaid program. There are lots of ways fraud can occur, here’s some examples:

• Billing for services that were never provided
• Billing for unnecessary services or supplies
• Billing for a more expensive service than was actually delivered
• Billing for the same service more than once
• Falsifying information on Medicaid applications

Prosecutors take Medicaid fraud very seriously. But not all billing errors or disputes amount to intentional fraud. An experienced attorney can argue your case and defend you against unfair allegations.

Penalties for Medicaid Fraud

If convicted of Medicaid fraud, there can be serious consequences:

• Criminal Penalties – This can include hefty fines and years in prison. Criminal charges can be brought under federal or state law.
• Civil Penalties – Even without criminal prosecution, the government can file a civil lawsuit seeking triple damages for fraudulent claims.
• Exclusion – You may be prohibited from participating in Medicaid, Medicare or other federal health programs.

With so much at stake, defending against Medicaid fraud accusations is critical. An attorney experienced with these complex cases can argue to have charges reduced or dismissed.

How Defense Attorneys Fight Medicaid Fraud

When facing Medicaid fraud allegations, your attorney’s in-depth knowledge of the law and investigative skills can mean the difference between prison or exoneration. Here are some of the ways they defend clients:

• Examine the Evidence – Pore through the state’s evidence to identify holes, inconsistencies or procedural mistakes.
• Challenge Witnesses – Question the credibility of witnesses and their potential bias.
• Raise Affirmative Defenses – For example, that the defendant made an honest mistake and lacked intent to defraud.
• Negotiate Lesser Charges – Argue for reduced penalties or dismissal of the most serious charges.
• Seek Statute of Limitations Dismissal – Charges must be brought within a certain time period or they can be dismissed.
• Argue Unconstitutionality – Claim that the defendant’s constitutional rights were violated.

An attorney well-versed in Medicaid law can analyze if fraud actually occurred or if errors were innocent mistakes. They can also negotiate with prosecutors for much less severe penalties.

Choosing the Right Medicaid Fraud Defense Lawyer

Not all attorneys have experience defending complex healthcare fraud cases. When looking for the best lawyer, consider these factors:

• Specialization – Search for attorneys who devote their practice to healthcare law and Medicaid fraud defense.
• Track Record – Look for a proven history of favorable verdicts and reduced penalties.
• Resources – Well-funded firms can afford teams of investigators, auditors and research attorneys.
• Reputation – Choose a respected lawyer known for ethical conduct and devotion to clients.
• Local Experience – Find someone familiar with the local prosecutors and their typical tactics.

Don’t leave your defense in the hands of just any lawyer. Medicaid fraud cases are intricate and require specialized legal knowledge. The consequences of conviction are dire. So take time to carefully select the best attorney for your needs.

The Investigation Process

If you learn you’re being investigated for Medicaid fraud, don’t panic but also don’t ignore it. Here’s what you can expect next:

• Record Subpoenas – The government requests medical and billing records.
• Interviews – Investigators may question doctors, staff and patients.
• Unannounced Site Visits – Agents inspect facilities and deliver more record subpoenas.
• Expert Audits – Forensic accountants review records looking for evidence of wrongdoing.
• Referral for Prosecution – If fraud is substantiated, charges are recommended.

Having an attorney early on can help respond to subpoenas, prepare you for interviews, and defend you before charges are filed. Don’t go it alone.

The Best Defense is a Good Offense

Your lawyer shouldn’t just react to the investigation – they should conduct a proactive defense. A good attorney will:

• Launch an independent audit to identify compliance gaps.
• Implement a corporate compliance program if you lack one.
• Train staff on proper billing and documentation.
• Make corrections for any past errors or misunderstandings.
• Approach prosecutors to demonstrate good faith.
• Negotiate repayments if any overbilling occurred.

By showing you’re a responsible provider committed to following the rules in the future, your attorney can often resolve the case without charges being filed.

Don’t Wait to Get Help

If contacted by investigators regarding Medicaid billing, you need legal guidance right away. Here are some of the reasons not to delay:

• Early cooperation can minimize penalties down the road.
• You may miss the deadline to appeal record subpoenas.
• Interviews with investigators can be perilous without counsel.
• Your attorney needs time to conduct their own audit and analysis.
• The government keeps expanding the probe the longer you wait.

Meeting with attorneys experienced in Medicaid fraud investigations soon after learning you’re under scrutiny can make all the difference. Don’t go it alone!

The Bottom Line

Medicaid fraud allegations can have devastating professional and personal consequences if not properly defended. You need knowledgeable legal counsel to protect your interests and provide skilled representation. Look for attorneys with specific experience in healthcare law and a proven track record with Medicaid fraud cases. With an experienced lawyer on your side, you can avoid fines, prison and other penalties – and safeguard your reputation and career.

Sources:

• Justice Department
• Office of Inspector General
• Centers for Medicare & Medicaid Services