Medicaid Hospice Benefits Fraud Defense

Defense Counsel for Audits and Health Care Fraud Investigations Involving Medicaid Hospice Benefits

Medicaid is the primary federal healthcare benefit program that provides coverage for home health and hospice care services. Under Medicaid’s Hospice Benefits Program, eligible healthcare providers can receive reimbursements for providing a wide range of services to terminally ill individuals.

However, due to widespread fraud, healthcare providers’ billings for home health and hospice services frequently come under scrutiny. This includes scrutiny in the form of both Medicaid audits and federal investigations targeting allegations of hospice and home healthcare fraud. These audits and investigations present substantial risks, and providers must defend themselves effectively in order to avoid facing unwarranted civil or criminal penalties.

We Defend Home Health Agencies and Hospice Care Providers Nationwide

Our lawyers defend home health agencies and hospice care providers nationwide. We have extensive experience defending clients against all types of Medicaid fraud allegations, and we handle matters involving all types of auditors and all federal enforcement authorities. This includes, but is not limited to:

• Fee-for-service audit contractors working with the Centers for Medicare and Medicaid Services (CMS)
• Federal Bureau of Investigation (FBI)
• U.S. Department of Health and Human Services Office of Inspector General (HHS OIG)
• U.S. Department of Justice (DOJ)
• U.S. Drug Enforcement Administration (DEA)

We handle cases involving allegations of Medicare fraud and fraud under other federal healthcare programs as well—and, in many cases, auditors and investigators will scrutinize providers’ billings under all applicable federal programs. As a result, providers facing hospice care fraud allegations involving their Medicaid billings could be at risk of facing other allegations as well, and this makes it critical to execute an informed and comprehensive defense strategy focused on avoiding both civil penalties and a criminal indictment.

Healthcare Fraud Matters We Handle

Within our healthcare fraud defense practice, we represent clients in all matters involving Medicaid’s Hospice Benefits Program. This includes representing clients in home health and hospice cases targeting allegations of:

False Claims Act Violations

Overbilling the federal government is the most common way that hospice care providers, home healthcare providers, assisted living facilities, and other providers commit health care fraud. Overbilling the federal government violates the False Claims Act; and, while most False Claims Act cases are civil in nature, evidence of criminal intent can lead to criminal prosecution by the DOJ.

Submitting claims with insufficient evidence of hospice care eligibility, billing for hospice care provided to ineligible patients, and a wide range of other intentional and unintentional violations can lead to enforcement under the False Claims Act. If your business or practice is facing accusations of overbilling Medicaid, we can help you avoid unnecessary consequences.

Anti-Kickback Statute Violations

We can also help you avoid unnecessary consequences if you are facing accusations of violating the Anti-Kickback Statute. The Anti-Kickback Statute is a federal law that makes it illegal to pay for end-of-life care patient referrals using Medicaid-reimbursed funds. Paying and receiving illegal kickbacks also violates the False Claims Act, and providers accused of offering or accepting improper payments can face substantial fines and other penalties.

Stark Law Violations

Similar to the Anti-Kickback Statute, the Stark Law also applies to referral fees (and other forms of remuneration) paid in relation to Medicaid patients. However, the Stark Law is specific to so-called “physician self-referrals.” If a physician refers a patient with a terminal illness to a related hospice care provider—even with a valid medical justification—this can potentially violate the Stark Law and create exposure to substantial civil monetary penalties.

Common Allegations in Medicaid Hospice Benefits Fraud Cases

Healthcare providers targeted in Medicaid hospice fraud cases under the False Claims Act, Anti-Kickback Statute, and Stark Law can face a wide range of allegations. When facing an audit or investigation, identifying the specific allegations at issue is critical for executing an effective defense. Some examples of common allegations in these cases include:

• Billing Medicaid for hospice services that lack medical necessity
• Billing Medicaid for medical care that was not actually provided
• Billing Medicaid for more expensive services than the services that were actually provided
• Misrepresenting hospice patients’ life expectancy in order to bill Medicaid
• Failure to treat patients in accordance with the standards for Medicaid eligibility
• Double-billing Medicaid and another public or private payor
• Identity theft and other fraud schemes used to improperly collect Medicaid reimbursements

But, again, these are just some of the most common allegations. Hospice care providers and other entities and individuals targeted in Medicaid audits and investigations can face numerous other allegations as well. Once you engage our law firm to provide representation, we will work quickly to discern the scope of the risk at hand, and then we will build and execute a custom-tailored defense strategy.

How Our Medicaid Fraud Defense Lawyers Can Help

Regardless of the circumstances at hand, if you are facing a Medicare hospice benefits audit or fraud investigation, there are several ways our lawyers can help. In this situation, our career defense lawyers and former federal prosecutors provide services including (but not limited to):

• Conducting an Internal Medicaid Compliance Assessment – Our lawyers will conduct a privileged assessment of your practice’s or business’s Medicaid compliance policies and billing documentation. If necessary, we can assess any risks of facing Medicare fraud or Tricare fraud allegations as well.
• Assessing the Scope (and Risks) of the Audit or Investigation – Along with assessing your practice’s or business’s compliance record, we will also assess the scope (and risks) of the audit or investigation.
• Building a Comprehensive and Custom–Tailored Defense Strategy – Once we have a clear understanding of the circumstances at hand, then we can build a comprehensive and custom-tailored defense strategy. Comprehensiveness and custom tailoring are key, as you must be prepared to defend against all of the specific allegations at issue.
• Intervening and Playing an Active Role in the Audit or Investigation – Our lawyers will intervene in the audit or investigation to ensure that the process is handled appropriately. After intervening, we will continue to play an active role until the process is over.  
• Targeting a Favorable Resolution that Avoids Unnecessary Consequences – As your defense counsel, we will be working to steer the inquiry toward a favorable resolution that avoids unnecessary consequences. With recoupments, fines, asset forfeiture, federal charges, and federal prison time all potentially on the table, it is imperative to protect yourself by all means available.

FAQs: Defending Against Allegations of Medicaid Hospice Benefits Fraud

Contact the Medicaid Hospice Benefits Fraud Defense Lawyers at Oberheiden P.C.

Our experienced defense lawyers are available to represent home health and hospice agencies in Medicaid billing audits and fraud investigations nationwide. To get started with a free and confidential consultation, call us at 888-680-1745 or tell us how we can get in touch online today.