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Medicaid/Medicare Fraud Defense Attorney

Understanding Medicaid and Medicare Fraud: Penalties and Defense Strategies

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.

George FernandezGeorge Fernandez
14:16 30 Apr 24
Excellent 10 out of 10, Helped resolve my case. Jeremy explained everything and made everything easy to understand.
21:33 24 Apr 24
If you are looking for a lawyer that listens, is aggressive where needed, and holds his word above all else, Todd is the best pick. I had hired multiple attorneys prior to hiring the Spodek Group for a white collar case. The first thing that stood out to me was the cost, as anyone going through the process and dealing with the system, money was tight at that time - especially after hiring and firing multiple lawyers. The cost was not as high as others which was definitely a plus. Todd's intake process was also unlike other attorneys. He took the time to actually listen. He cared. He was trying to put himself in my shoes while I was explaining the situation to him and he really took the time to understand the whole situation. Other lawyers will give you 15 mins and send you a retainer agreement. Not Todd, I think he spent almost two hours with me as I was explaining everything.Not only was he great during the onboarding process, he was supportive and very informative through the entire plea process and eventually sentencing. After hiring him, I asked if I should hire a prison consultant, he told me to save my money as he would do everything they would. He was right and held up to his word. Later on I would hear from others that went with the prison consultants that they were a waste of money - I am glad I listened to Todd!When it came time for sentencing, two days prior to sentencing, the prosecutor tried increasing my proposed prison time by almost double - apparently a normal move. Todd and his team worked with me non-stop through the weekend prior to sentencing to ensure that I was not given additional prison time. Again, he took the time to listen and came up with a strategy to explain the case with great detail.Unfortunately, I did plead guilty as that was my best option. Todd and his whole team wrote up nearly 300 pages of a summary of what happened and why I should not be given prison time. If I breakdown the amount I spent with Todd versus the amount of work that I saw being done, I am shocked I was not charged four times as much. The other benefit was, a lot of criminal defense lawyers were just a single attorney with a paralegal or two. Todd had a team of people that I dealt with (5-7 people that I interacted with), but he was ALWAYS accessible. It would never take him more than an hour to reply unless he was in court.I was sentenced to prison and I was emotionally distraught. Todd and his team did whatever they could even after sentencing to make sure I was alright. He personally stayed in touch with my family to ensure I was doing alright and offered support to them. Most lawyers would consider the job complete at sentencing, not Todd.After prison, Todd still spent time with me to make sure I was on the right track and avoiding any potential risks in the future. He has also been giving advice on how to navigate probation etc and has not been looking at the clock for billing.Although I wish I had never been arrested in the first place, I am glad I had Todd and his team in my corner. Without them I likely would have had to spend a lot more time in prison than I did.Thank you, Todd, and the entire Spodek Law team, for helping turn what was a nightmare into a manageable situation!
Yelva Saint-PreuxYelva Saint-Preux
19:26 19 Apr 24
I am immensely grateful to the entire team at Spodek Law Group for their unwavering dedication and exceptional expertise throughout my case. From our initial consultation to the final resolution, their professionalism and tireless advocacy made all the difference. Their strategic approach and attention to detail instilled confidence in me every step of the way.Thanks to their hard work and commitment, we achieved a truly favorable outcome that exceeded my expectations. Not only did they navigate the complexities of my case with precision, but they also provided invaluable support and guidance during what was undoubtedly a challenging time. I cannot recommend Spodek Law Group highly enough, especially attorneys Todd Spodek and Claire Banks; they are beacons of excellence in the legal profession.YSP.
Katherine SunKatherine Sun
18:08 18 Apr 24
my lawyer is Alex Zhik. Efficient, patient and professional
Nun yaNun ya
17:48 18 Apr 24
Todd, Ralph and Alex are amazing. Helped my husband get from a double digit number with multiple charges to a single digit, by the time I blink he will be out. They very professional and help with all your needs. They dealt with my anxiety and worry very well and they understand that your family member needs to get home as soon as possible.
Keisha ParrisKeisha Parris
20:45 15 Mar 24
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko BeautyTaïko Beauty
16:26 15 Mar 24
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence.Thank you team!
K MarK Mar
01:37 25 Jan 24
I recently had Spodek Law Group represent me for a legal matter in NYC and I am thoroughly impressed with their services.Alex Zhik secured the best possible outcome for my case.It was a seamless journey from the initial consultation to the resolution of my legal matter. From the moment I spoke to Todd about my case, his enthusiasm to help was evident, setting a positive tone for the entire experience. The efficiency and professionalism displayed by the team is commendable.A particularly noteworthy aspect of their service is their user-friendly portal to upload your documents/evidence. This not only simplified the process, but showcases their commitment to streamline the client experience.Lastly, in an industry where legal fees can often be a concern, I found their pricing to be very reasonable, making needing legal assistance feel accessible and stress-free.I am grateful for their support and wouldn't hesitate to turn to them again in the future.

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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