Medicaid Behavioral Health Services Fraud Defense
Healthcare Fraud Defense Lawyers for Behavioral Health Services Providers Accused of Submitting False Claims to Medicaid
If your practice is facing a billing audit or Medicaid fraud investigation related to its billings for behavioral health services, you need experienced legal representation. These are high-risk inquiries; and, if auditors or Medicaid fraud investigators uncover evidence (or apparent evidence) of improper billings or referral fees, this can potentially lead to civil or criminal charges depending on the circumstances involved.
We defend behavioral health services providers nationwide. If your practice is facing scrutiny related to its Medicaid program billings, we can help you target a favorable resolution that avoids federal healthcare fraud charges. Time is of the essence in this scenario, so we strongly encourage you to schedule a free consultation at our firm promptly.
Understanding the Federal Laws that Apply to Behavioral Health Services Providers that Bill Medicaid
Federal authorities investigate Medicaid fraud under several federal statutes. Federal prosecutors pursue civil and criminal charges under several federal statutes as well. If your practice is facing a billing audit or Medicaid investigation related to its behavioral health services, auditors or investigators are most likely looking for evidence that your practice has violated one or more of the following:
The False Claims Act
The False Claims Act prohibits healthcare providers from submitting false or fraudulent claims for reimbursement under Medicaid and other federal government programs. “False or fraudulent claims” can take many different forms, including (but not limited to):
- Billing for medically unnecessary services provided to Medicaid beneficiaries
- Billing for services provided by unqualified mental health professionals
- Billing for services that are not eligible for reimbursement (including ineligible psychiatric services)
- Double-billing under Medicaid and another healthcare benefit program
- Making false statements relating to patient or services eligibility
- Relying on falsified medical records, falsified billing records, or other fraudulent documentation to substantiate Medicaid billings
- Upcoding, unbundling, and other forms of billing fraud
When facing scrutiny related to Medicaid payments, it is imperative that health care providers have a clear and comprehensive understanding of the risks involved. This involves promptly conducting a comprehensive billing compliance assessment, and targeted providers should engage experienced defense counsel to examine their claims data as soon as possible.
The Anti-Kickback Statute
The Anti-Kickback Statute prohibits healthcare providers from compensating patient referral sources using Medicaid-reimbursed funds. It also prohibits healthcare providers from accepting referral fees and other forms of remuneration in a wide range of circumstances. The U.S. Department of Justice (DOJ) regularly targets physician practices, home health agencies, clinics, hospitals, Medicaid managed care organizations (MCOs), and other entities under the Anti-Kickback Statute, and Medicaid fraud cases under the statute can lead to civil or criminal fines (among other serious penalties).
The Stark Law (the “Physician Self-Referral Law”)
The Stark Law (also known as the “Physician Self-Referral Law”) makes it unlawful for physicians and related injuries to refer patients in exchange for financial compensation. While various safe harbors and exceptions apply, steep civil penalties apply as well. If you are being accused of offering or accepting unlawful referral fees in relation to behavioral health services covered under a state Medicaid program, you need to promptly develop a cohesive defense strategy based on the specific allegations at the center of the government’s case.
The Federal Healthcare Fraud Statute
The federal healthcare fraud statute (18 U.S.C. Section 1347) imposes criminal penalties for all forms of intentional fraud related to the provision of federally funded behavioral health services. We have extensive experience representing clients in these high-stakes healthcare matters; and, if you are facing scrutiny from federal law enforcement authorities under Section 1347, you need experienced defense counsel who can fight to help you avoid criminal action.
Other Federal Attempt, Conspiracy, and Anti-Fraud Laws
Along with the laws discussed above, several other laws at the federal level allow the DOJ and other agencies to target behavioral health services providers suspected of defrauding Medicaid. From fraudulent claims submitted without proof of medical necessity to illegal kickbacks and prescription practices, we defend providers who are facing all types of allegations from the DOJ, U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), and other federal authorities.
Understanding the Risks of Facing a Medicaid Behavioral Health Services Fraud Investigation
If your behavioral health practice is facing scrutiny related to alleged fraudulent billing practices or other unlawful conduct, it is imperative to understand the risks involved. This starts with understanding whether you are facing an audit, civil investigation, or criminal investigation. While auditors have the authority to seek recoupments and impose pre-payment review, civil investigations can lead to penalties including:
- Civil monetary penalties
- Treble damages
- Exclusion from Medicaid and other federal programs
In criminal cases, targeted providers can face additional penalties including:
- Criminal fines
- Federal imprisonment
Under federal law, Medicaid fraud and attempt to commit Medicaid fraud are generally subject to the same penalties, and providers targeted in criminal cases will frequently face charges for mail fraud, wire fraud, conspiracy, and other federal crimes as well. The federal government is committed to combating fraud involving Medicaid-reimbursed behavioral health services, and this makes it critical for targeted providers to immediately get to work building an effective defense strategy.
We Defend Healthcare Providers Accused of Submitting False or Fraudulent Claims to Medicaid Nationwide
Our Medicaid fraud defense lawyers represent behavioral health services providers and other clients nationwide. We handle Medicaid billing audits and investigations involving all federal agencies, and we are equally comfortable helping clients respond to audit notices, civil investigative demands (CIDs), target letters, and subpoenas. Regardless of the circumstances at hand, if your practice is facing scrutiny related to its Medicaid billings, we can help—but it is important that you contact us right away.
Which government agencies audit and investigate Medicaid fraud involving behavioral health services?
Several government agencies audit and investigate Medicaid fraud involving behavioral services. At the federal level, these include the U.S. Department of Justice (DOJ), Department of Health and Human Services Office of Inspector General (HHS OIG), and Federal Bureau of Investigation (FBI), among others. The Centers for Medicare and Medicaid Services (CMS) rely on private audit contractors to uncover Medicaid fraud as well. State agencies also investigate cases of suspected Medicaid fraud in certain circumstances.
What should I do if my behavioral health services practice is being audited?
If your behavioral health services practice is being audited, you should engage experienced defense counsel promptly. Regardless of your practice’s billing compliance record, you will need to defend against the audit effectively to avoid unnecessary consequences. Our lawyers have extensive experience representing clients during Medicaid audits; and, while every case is unique, we have an extensive track record of helping our clients avoid civil and criminal penalties. As your practice’s audit defense counsel, we will:
- Promptly conduct an attorney-client privileged Medicaid billing compliance assessment
- Develop a custom-tailored audit defense strategy
- Communicate directly with the auditors on your behalf
- Oversee the audit process and intervene as necessary
- Steer the audit toward a favorable resolution as efficiently as possible
To learn more about our firm’s Medicaid audit defense practice, contact us today. We will arrange for you to speak with one of our senior attorneys in strict confidence as soon as possible.
What should I do if I received a target letter or subpoena from the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG)?
If you received a target letter or subpoena from the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), you should engage experienced defense counsel promptly in this scenario as well. This is a high-risk legal matter, and you will need experienced legal counsel who can communicate effectively with federal agents and prosecutors on your behalf.
When can allegations of Medicaid behavioral health services fraud lead to federal charges?
Allegations of Medicaid behavioral health services fraud can lead to federal charges if an audit or investigation uncovers evidence of improper or unsubstantiated billings. Crucially, overbillings do not have to be intentional to be classified as fraudulent under federal law. While evidence of intent is required for prosecutors to pursue criminal fraud charges, unintentional fraud can expose providers to substantial monetary penalties.
Can your firm also provide representation for Medicare fraud defense?
Yes, we represent healthcare providers and other entities facing accusations of attempting to defraud Medicare, Medicaid, and other federal healthcare benefit programs. If your behavioral health practice is facing Medicare fraud allegations as well, we can provide strategic defense representation for all of the allegations at issue.
Contact the Medicare and Medicaid Fraud Defense Lawyers at Oberheiden P.C.
If you would like to speak with one of our Medicare and Medicaid fraud defense lawyers, we encourage you to contact us promptly. To arrange a complimentary initial consultation as soon as possible, call 888-680-1745 or tell us how we can reach you online today.
Additional Medicaid Pages
- Medicaid Fraud Lawyer
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- CMS Medicaid Suspension Defense and Medicare Suspension Defense
- Medicaid Preventive Health Care Fraud Defense
- Medicaid Autism Services Fraud Defense
- Medicaid Dental Care Fraud Defense
- Medicaid Hospice Benefits Fraud Defense
- Medicaid Alternative Benefit Plan Fraud Defense
- Medicaid Transportation Coverage Fraud Defense
- Medicaid Reentry Services Fraud Defense
- Medicaid Mandatory Benefits Fraud Defense
- Medicaid Early and Periodic Screening Fraud Defense
- Medicaid Fraud Defense for Hospice Businesses
- New York Medicaid Fraud Defense
- California Medicaid Fraud Defense
- Minnesota Medicaid Fraud Defense
- Telehealth Medicaid Fraud Defense
- Pharmacy Medicaid Fraud Defense
