Medicaid has grown over the years with the aim of offering medical services to low-income earners in the United States. The federal government’s support of the program has seen more families have access to health care. However, with the growth came several fraud issues and Medicaid fraud by healthcare providers. If your institution is being investigated for healthcare related fraud activities, or charges of fraud are levied against you, it is important to hire the services of a new county Medicaid fraud lawyer. It is also prudent on your part to understand what the law provides as undertakings that are fraudulent in nature.
Here is a look at the federal laws that govern the Medicaid program. They detail the fraud issues and the possible penalties an institution may face if found guilty.
Federal False Claims Act (FCA)
The law was enacted as a safeguard against an overcharge to the federal government. The Act further protects the government from liabilities arising from contractual payments in the event inferior products or services are supplied to the government.
The law provides for a civil action against any party that knowingly submits or leads to the submission of a false claim to the government. In such an instance, there is no proof required as to a specific intent by the accused party to defraud the federal government. The penalty in the civil matter attracts a fine of not less than $5,000 with a maximum of $10,000 including three times the amount in damages the government incurred as a result of the act. The FCA statute provides for a criminal action in fines, a jail term or both in situations where parties submit false claims.
Anti-Kickback Statute (AKS)
It is criminal, as per the Act, for any party, knowingly offering, paying or soliciting payment, directly or indirectly with the aim of making a referral to services or items that ought to be reimbursed by the federal government through the health care program. Any party found guilty, may be fined civil penalties that may amount to $73,588 per payment including three times the kickback sums. Criminal charges include fines, a jail term or both for those found in violation of the statute.
Physician Self-Referral Law, (Stark Law)
Under the Stark Law, physicians are barred from making any referral for the health services payable by Medicaid to a health facility the physician has an interest in, is a director/ owner of, or has a compensation plan with the service. The services are inclusive of; clinical laboratory services, home health services, DME and supplies, radiation therapy, imaging services, physical therapy, inpatient and outpatient services, occupational therapy as well as outpatient prescription drugs delivery. The law is a strict liability statute. Therefore, intent is not required as proof in the case against the entity. Any violation of the Stark law attracts a penalty of up to $23,863 for each referred service in addition to repayment of the claims and a potential exclusion from all federal related healthcare programs.
Criminal Health Care Fraud Statute
Any act executed with full knowledge of any party, to defraud the health care program or obtain sums or properties under the care of or owned by the healthcare benefit program, shall attract criminal proceedings against them with the ultimate payment of a fine or jail term, or both.
To avoid paying such hefty fines or serving a sentence, it is important you hire the services of an experienced Medicaid fraud attorney. Their experience will help craft a winning strategy for your defense if the matter is brought before a review board or presented before a court of law. The federal government draws testimonies from medical billers or analysts whose input is in support of the fraud charges. As part of a winning strategy, drawing up defenses for your case is crucial. Here is a look at the possible arguments that may be of use to beat the fraud charges.
Legal Defenses to Medicaid Fraud
Lack of Knowledge of the Falsity
For the court to arrive at a guilty conviction against you, the defendant, there has to be no doubt that you knowingly committed the fraudulent activity. A fraud attorney would present a strong “absence of knowledge” defense if you were not aware that the action was false.
The duress defense is used in the likely event you were forced to transacting against your will owing to a threat of harm against you.
Withdraw from Conspiracy
Some situations will have the prosecution alleging your involvement in a plot to commit Medicaid fraud. You could avoid these charges by proving your withdrawal from the activities that led to the fraudulent deeds before it was committed.
The Medicaid program is filled with paperwork. At times, there are no witnesses when the paperwork is filled. This creates an avenue for any other party to falsifying a document in your name. Without any documented evidence of your involvement, a fraud attorney could present a case for mistaken identity in your defense.
Healthcare fraud has proven to be a very complex area of law and as such highly experienced lawyers are required with the ever changing legal environment. The penalties involved in case of a conviction of health care fraud, making it more important to consider hiring the services of a fraud lawyer.