Minnesota Medicaid Fraud Defense

Experienced Health Care Fraud Defense Attorneys for Medicaid Fraud Cases in Minnesota

Health care fraud schemes involving Medicaid have led to intensive scrutiny across Minnesota. If you are under investigation or facing charges for submitting false or fraudulent claims under Medicaid, you are facing serious risks, and you should discuss your legal options with an experienced Medicaid fraud defense lawyer promptly.  

Facing Medicaid fraud allegations is an extremely serious matter. This is especially true for healthcare providers and other entities and individuals in Minnesota—where the U.S. Department of Justice (DOJ), U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), and other federal authorities are aggressively pursuing Medicaid fraud enforcement. Allegations of Medicaid fraud can lead to civil or criminal charges; and, in criminal cases, targeted individuals can potentially face long-term imprisonment.

At Oberheiden P.C., we have a proven track record of successfully defending clients in the healthcare industry against Medicaid and Medicare fraud allegations. We represent other clients in these cases as well. If you are under investigation or facing charges for Medicaid fraud, conspiracy to commit fraud, or any other related offense, our team can help protect you—as long as you contact us in time.

Common Healthcare Fraud Charges Under Medicaid

Medicaid fraud allegations can take many different forms. We have seen this recently in Minnesota in particular—with state and federal authorities targeting entities and individuals for alleged fraud under various Medicaid programs. Some examples of more-common allegations under Medicaid include:

• Billing for services that lack medical necessity
• Billing for services provided by unlicensed support staff
• Failing to maintain medical records to substantiate Medicaid billings
• Seeking reimbursement for services not actually provided to patients
• Submitting false statements and forged documents to support fraudulent Medicaid billings

These allegations (among many others) can lead to civil or criminal prosecution for charges including:

Federal False Claims Act Violations

Federal prosecutors rely heavily on the False Claims Act to pursue both civil and criminal charges against defendants in Medicaid fraud cases. Doctors, hospitals, clinics, pharmacies, nursing homes, autism care providers, and other entities and individuals can all face charges under the False Claims Act based on allegations of defrauding (or attempting to defraud) Medicaid programs in Minnesota.

In civil cases, False Claims Act enforcement actions can lead to liability for recoupments, treble damages, fines, and other financial penalties, as well as possible Medicaid exclusion. In criminal cases, fines and prison time are on the table.

Minnesota False Claims Act Violations

The Minnesota False Claims Act also imposes substantial penalties for Medicaid fraud. Similar to the federal False Claims Act, the Minnesota False Claims Act prohibits all forms of fraud and abuse under the state’s Medicaid programs—from seeking payments unlawfully to using money received through Medicaid to pay illegal kickbacks and referral fees.

Anti-Kickback Statute and Stark Law Violations

While illegal kickbacks and referral fees can violate both the federal and state False Claims Acts, they can also violate the federal Anti-Kickback Statute and Stark Law. The Anti-Kickback Statute includes provisions for both civil and criminal enforcement; and, in criminal cases, potential penalties include up to a $100,000 fine and 10 years of imprisonment in some cases. The Stark Law prohibits “physician-self referrals,” and unlawful fees paid between physicians and related businesses can lead to fines and other financial penalties.

Other State and Federal Offenses

Along with False Claims Act, Anti-Kickback Statute, and Stark Law violations, allegations of Medicaid fraud in Minnesota can lead to charges for various other state and federal offenses as well. For example, under the federal healthcare fraud statute (18 U.S.C. Section 1347), defrauding Medicaid can lead to substantial fines and a 10-year prison sentence—and this increases to 20 years in cases involving serious bodily injury to patients.

What to Know if You Are Facing a Health Care Fraud Case in Minnesota

If you are facing scrutiny from the government in Minnesota related to your business’s or practice’s Medicaid billings, it will be critical to ensure that you are making informed decisions going forward. Our experienced team can provide the advice and insights you need, and we can work with the relevant state or federal agencies to pursue a favorable outcome on your behalf.

Here are three critical facts to know in this scenario:

1. Facing Medicaid Fraud Allegations Poses Substantial Risks

As we touched on above, facing Medicaid fraud allegations poses substantial risks. Facing credible allegations of Medicaid fraud from the DOJ, HHS OIG, or Minnesota’s Medicaid Fraud Control Unit (MFCU) can lead to civil or criminal charges, and potential penalties can include:

• Civil or criminal fines
• Liability for recoupments and treble damages
• Liability for attorneys’ fees and costs
• Medicaid suspension or exclusion
• State or federal imprisonment

State and federal authorities in Minnesota maintain a zero-tolerance policy for Medicaid fraud. As a result, if you are facing allegations of Medicaid fraud, it is imperative that you engage experienced defense counsel immediately.

2. There Are Several Potential Defenses to Medicaid Fraud Allegations

While facing Medicaid fraud allegations poses substantial risks, there are also several potential defenses to these allegations in both state and federal cases. For example, depending on the circumstances involved, some examples of potential defense strategies include:

• Demonstrating compliance with Medicaid’s complex billing regulations to overcome allegations of upcoding, unbundling, or other coding violations
• Providing adequate medical documentation to support claims of medical necessity and to confirm that medical services were provided as billed.
• Exposing issues with the government’s efforts to gather information and build its case, such as showing that your business’s or practice’s higher-than-average reimbursement rates are justified based on its unique circumstances.
• Challenging the evidence behind the government’s Medicaid fraud allegations to demonstrate that formal charges are unwarranted and cannot be proven.
• In criminal cases, disputing allegations of intent to defraud Medicaid (though inadvertent billing errors can still lead to civil liability).

Again, these are just examples. When you engage the attorneys on our Minnesota Medicaid fraud defense team, our attorneys will thoroughly assess the circumstances of your case in order to identify all viable defenses under the specific circumstances at hand.

3. Executing an Informed and Proactive Defense Strategy is Critical

When facing allegations of Medicaid fraud, executing an informed and proactive defense strategy is critical for avoiding unnecessary consequences. While our attorneys can fight to secure a favorable resolution on your behalf, we can only do so if you contact us in time.

With this in mind, if you have been accused of Medicaid fraud in Minnesota, we strongly encourage you to contact us immediately. Once you get in touch, we will arrange for you to speak with the attorneys on our Medicaid fraud defense team as soon as possible, and we can provide representation on an emergency basis if necessary.

FAQs: Defending Against Allegations of Billing Fraud and Other Medicaid Violations

Schedule a Free and Confidential Consultation with a Senior Minnesota Medicaid Fraud Defense Attorney at Oberheiden P.C.

If you need to speak with an experienced Minnesota Medicaid fraud defense attorney, we strongly encourage you to contact us right away. To schedule a free and confidential consultation with a senior attorney at Oberheiden P.C. as soon as possible, call 888-680-1745 or inquire online now.