Medicare/Medicaid Billing Fraud Charges?
Medicare and Medicaid Billing Errors Can Lead to Serious Allegations of Fraud and Abuse
If you have been charged with Medicare fraud or Medicaid fraud, you are facing serious consequences. Federal authorities vigorously enforce compliance under these federal health care programs, and medical providers (and other individuals and entities) accused of fraud can face civil or criminal penalties depending on the circumstances involved.
As a result, in this scenario, an effective defense is critical. At Oberheiden P.C., we have extensive experience defending clients accused of submitting fraudulent claims, paying illegal kickbacks, accepting illegal kickbacks for patient referrals, and numerous other forms of Medicare and Medicaid fraud. If you are facing charges, we can help—but it is important that you contact us right away.
We Defend Providers Facing Charges from the HHS Office of Inspector General and the Justice Department
While the Centers for Medicare and Medicaid Services (CMS) audits providers through its fee-for-service contracting system, enforcement actions generally involve either the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) or the U.S. Department of Justice (DOJ). Not only does our team have deep experience defending clients against charges from HHS OIG and the DOJ, but many of our lawyers prosecuted healthcare fraud cases on behalf of the federal government before entering private practice.
We defend physicians and other medical professionals, substance abuse treatment services providers, applied behavior analysis (ABA) service providers, durable medical equipment (DME) companies, and a wide range of other clients accused of fraud under the Medicare and Medicaid programs. Regardless of the substance and veracity of the allegations at issue, our lawyers can build and execute a comprehensive defense strategy focused on securing a favorable resolution that protects you against going in front of a federal jury.
Matters We Handle
Within our Medicare and Medicaid fraud defense practice, we defend clients against all types of civil and criminal allegations. We regularly provide representation for matters including (but not limited to):
False Claims Act Cases
The False Claims Act prohibits medical providers and other entities from submitting “false or fraudulent claims” for reimbursement under Medicare and Medicaid. If your business or practice is being accused of improperly receiving Medicare or Medicaid funds, we can use our experience to pursue a favorable resolution with the federal government on your behalf. We handle all types of False Claims Act cases, including those involving allegations of:
Billing Errors Under Medicare and Medicaid
While billing errors under Medicare and Medicaid will lead to civil enforcement actions in most cases, HHS OIG and the DOJ can (and do) pursue criminal charges in cases involving suspected intentional billing fraud. We have experience in cases involving:
- Billing for ineligible services provided to Medicare beneficiaries or Medicaid beneficiaries
- Billing for substandard services that do not meet the criteria for Medicare or Medicaid reimbursement
- Upcoding, unbundling, and other Medicare and Medicaid coding violations
- Using a patient’s Medicare number or Medicaid number to bill for services not provided
- Submitting false records or false statements in support of fraudulent program billings
These are just examples. If your practice or business is facing any allegations of improperly billing Medicare or Medicaid to secure unauthorized benefits, our team can quickly get to work building a defense strategy that is tailored to the circumstances at hand.
Double-Billing Medicare/Medicaid and Private Health Insurance Providers
Double-billing Medicare or Medicaid and private health insurers also violates the False Claims Act. Whether intentional or inadvertent, billing the federal government and a private insurance company for the same services can lead to serious allegations and substantial penalties under federal law.
Other Fraud Schemes Involving Medicare and Medicaid
From taking advantage of vulnerable citizens who have Medicare cards to money laundering schemes involving illegally obtained Medicare and Medicaid funds, we defend clients accused of other types of fraud schemes as well. If you are facing any allegations related to fraudulently obtaining taxpayer dollars under one of these programs, our team can fight to protect you against unnecessary consequences.
Anti-Kickback Statute Cases
The Anti-Kickback Statute allows HHS OIG and the DOJ to pursue charges against healthcare providers and other individuals and entities that offer, pay, solicit, or receive improper fees for referring patients covered under Medicare and Medicaid. Similar to the False Claims Act, the Anti-Kickback Statute includes provisions for both civil and criminal enforcement. From physicians to nurse practitioners, and from pharmaceutical companies to DME companies, a wide range of individuals and entities can face serious charges related to illegal payments for patient referrals.
Other Healthcare Fraud Cases
Along with False Claims Act and Anti-Kickback Statute cases, we defend clients in other healthcare fraud cases as well. This includes cases involving not only HHS OIG and the DOJ, but also other agencies such as the Drug Enforcement Administration (DEA). From diversion of controlled substances to billing for patient care provided without a medical license, Medicare and Medicaid billing fraud charges can take many different forms—and, in all cases, an informed, strategic, and proactive defense is required.
What to Do if You Are Facing Medicare or Medicaid Billing Fraud Charges
If you are facing Medicare or Medicaid billing fraud charges, your defense needs to be your priority. While negotiating civil settlements (if not avoiding liability entirely) may be on the table in many cases, substantial civil or criminal penalties may be on the table as well. With this in mind, in this scenario, it is important to:
- Promptly Engage Experienced Defense Counsel – Defending against allegations of Medicare or Medicaid fraud requires highly experienced legal representation. As soon as possible, you should engage a defense team that has specific and extensive experience handling these kinds of cases.
- Make Sure You Know the Nature and Scope of Your Charges – It is critical to make sure you know the nature and scope of the charges against you. What type (or types) of fraud is the federal government alleging? Are you facing civil or criminal prosecution?
- Gather Evidence and Build an Informed Defense Strategy – Once you know what you need to defend against, then you can focus on building an informed defense strategy. Working with your defense counsel, you should identify and preserve all relevant evidence and then begin the process of pursuing a favorable resolution.
- Target a Resolution that Avoids a Federal Jury Trial – If at all possible, you will want to target a resolution that avoids a federal jury trial. There are no guarantees at trial, and securing a favorable pre-trial resolution will allow you to move on from the allegations as soon as possible.
- Make Informed Decisions Focused on the Future – Throughout the process, you should be making informed decisions focused on the future. For example, if your business’s program eligibility or your medical license is in jeopardy, these are critical factors that should be central to your decision-making.
FAQs: Defending Against Health Care Fraud Allegations Under Medicare and Medicaid
Why am I facing Medicare or Medicaid billing fraud allegations?
Healthcare providers and other individuals and entities can face Medicare and Medicaid billing fraud allegations for various reasons. In some cases, patients and other concerned citizens report fraud (or suspected fraud) to the federal government. In others, employees’ reckless disregard of their responsibilities can lead to billing errors that trigger red flags for CMS or HHS OIG. Providers that have been held responsible for billing errors in previous years can be at increased risk of facing scrutiny as well.
What should I do if I am facing Medicare or Medicaid fraud charges?
If you are facing Medicare or Medicaid fraud charges, you need to be extremely careful. To ensure that you are making informed decisions and avoiding mistakes that could increase the risks involved, you should engage experienced defense counsel promptly.
What should I avoid doing if I am facing Medicare or Medicaid fraud charges?
When you are facing allegations of Medicare or Medicaid fraud, it is critical to avoid improperly billing the federal government under either of these programs. Once you engage experienced defense counsel to fight your Medicare or Medicaid charges, your defense counsel will be able to assess whether any changes to your practice’s or business’s billing protocols are necessary.
Should I engage a law firm to help me defend against Medicare or Medicaid fraud allegations?
Yes, due to the substantial risks involved, it is critical to engage a law firm to help you defend against Medicare or Medicaid fraud allegations. This is not a situation that you should try to handle on your own.
What are the penalties for Medicare fraud and Medicaid fraud?
The penalties for Medicare fraud and Medicaid fraud depend on the specific violation (or violations) involved—including whether the violations are civil or criminal in nature. Generally, however, potential penalties in these cases include recoupments, treble damages, fines, program exclusion, and even federal prison time.
Contact the Medicare and Medicaid Fraud Defense Lawyers at Oberheiden P.C.
If you are facing Medicare or Medicaid fraud charges, we strongly encourage you to contact us right away. To speak with a senior defense lawyer at Oberheiden P.C. as soon as possible, call 888-680-1745 or tell us how we can reach you online now.