Medicaid Preventive Health Care Fraud Defense

Defense Counsel for Preventive Health Care Providers Facing Medicaid Fraud Audits, Investigations, and Charges

Medical providers that offer preventive health care services to Medicaid beneficiaries must strictly comply with the program’s billing rules and requirements. Among other requirements, preventive health care services reimbursed through the Medicaid program must satisfy the program’s definition of “medical necessity,” and providers must ensure that they code their billings properly.

Failure to meet these requirements—among many others—can expose healthcare providers to civil or criminal penalties for Medicaid fraud.

Our lawyers handle Medicaid fraud cases nationwide. We also defend healthcare entities that are facing Medicaid billing audits and fraud investigations. These are high-risk inquiries, and avoiding unnecessary consequences requires an informed and strategic defense.

Our Services for Medicaid-Participating Preventive Health Care Providers

We defend healthcare providers that are facing audits, investigations, and charges under Medicaid and all other federal health care programs. Within our Medicaid fraud defense practice, our services include:

Medicaid Billing Audit Defense

Fee-for-service contractors working with the Centers for Medicare and Medicaid Services (CMS) aggressively audit Medicaid-enrolled preventive health care providers. If an auditor uncovers evidence that a provider has obtained improper federal health care payments through Medicaid, it can impose recoupments and other penalties. In severe cases, Medicaid audits can also lead to prepayment review or even Medicaid exclusion.

Federal Civil Liability Defense

We also defend preventive health care providers that are facing civil monetary penalties for alleged Medicaid fraud. Civil penalties in Medicaid fraud cases can be substantial, and avoiding these penalties requires an in-depth understanding of the relevant federal statutes and regulations. If your preventive health care practice is facing civil fines related to allegations of Medicaid billing fraud, our lawyers can deal with the federal government on your behalf.

Federal Criminal Defense

We provide criminal defense representation as well. Whether you have concerns about criminal culpability or you received a federal criminal indictment, our lawyers can help you understand what is at stake in your case and make informed decisions about your next steps. In criminal Medicaid fraud cases, federal prison time is on the table; and, even if you are able to avoid prison time, a federal conviction could be devastating to your medical practice.

Medicaid Preventive Health Care Fraud Cases We Handle

In each of the scenarios discussed above, we defend preventive health care providers against all types of federal allegations. Whether you are facing a Medicaid billing audit, a government investigation, or civil or criminal enforcement action, we can provide strategic representation for:

False Claims Act Cases

The False Claims Act prohibits all Medicaid enrollees from submitting “false or fraudulent claims” for reimbursement. This can involve a wide range of fraudulent practices, including (but not limited to):

• Billing Medicaid for medically unnecessary services
• Billing Medicaid under false or fraudulent pretenses
• Billing for services provided by individuals without the requisite professional licenses
• Double billing for the same service (which can also lead to allegations of private insurance fraud)
• Falsifying patients’ medical records to support fraudulent Medicaid billings
• Making false statements to support fraudulent Medicaid billings
• Upcoding, unbundling, submitting duplicate claims, and other forms of improper billing

While most False Claims Act cases are civil in nature, federal prosecutors can pursue criminal charges when they can prove actual knowledge or willful fraud. Our lawyers can assess your likelihood of facing criminal fines and prison time; and, regardless of the risks at hand, we will work to secure a favorable resolution that protects your ability to practice.

Anti-Kickback Statute Case

The Anti-Kickback Statute prohibits preventive health care providers, home health agencies, and other individuals and entities in the health care industry from offering, paying, soliciting, and receiving referral fees in exchange for referrals of Medicaid beneficiaries. Individuals and entities accused of making prohibited referrals or accepting prohibited referral fees can face civil or criminal charges depending on the specific nature of the allegations at issue.

Stark Law Cases

The Stark Law (also known as the Physician Self-Referral Law) applies to physicians and related entities that provide certain designated health services. Physicians and related entities that provide these designated health services must avoid any compensation arrangement or other financial interest that results in the improper transfer of Medicaid funds. While various safe harbors are available, physicians and related entities must generally structure their financial arrangements with a specific safe harbor in mind.

Other Types of Healthcare Fraud Allegations

Along with False Claims Act, Anti-Kickback Statute, and Stark Law violations, we defend individuals and entities that are facing other types of healthcare fraud allegations as well. We handle matters involving all federal agencies, state Medicaid agencies, and audit contractors; and, in all cases, we rely on our lawyers’ extensive experience to protect our clients’ interests by all means available.

Why Choose Oberheiden P.C. for Medicaid Preventive Health Care Fraud Defense?

If you need to defend against allegations (or potential allegations) of preventive health care fraud under Medicaid, why should you choose Oberheiden P.C.? Here’s what we offer:

• We Have Extensive Experience Handling Medicare and Medicaid Fraud Matters – Our lawyers have extensive experience representing clients in Medicaid fraud, Medicare fraud, and other federal healthcare fraud matters.
• Several of Our Lawyers Used to Prosecute Health Care Fraud at the DOJ – Before entering private practice, several of our lawyers served as health care fraud prosecutors at the DOJ—overseeing investigations and pursuing charges in the federal courts.
• We Take a Team Approach to High–Stakes Medicaid Fraud Defense – Our lawyers work as a team in every case we handle, ensuring that every client receives the full benefit of their collective experience.
• Our Defense Team Can Get to Work Immediately if Necessary – If you are in urgent need of legal advice or representation, our defense team can get to work immediately. If you are actively facing scrutiny, this includes immediately intervening in the audit or investigation.
• We Have a Proven Track Record of Success in Federal Healthcare Fraud Matters – Our team has a proven track record of success in federal healthcare fraud matters. This includes securing favorable results in high-stakes Medicaid audits and investigations.  

FAQs: How to Handle a Medicaid Billing Audit or Preventive Health Care Fraud Investigation

Contact the Federal Healthcare Fraud Lawyers at Oberheiden P.C.

If you need to know more about defending against allegations (or potential allegations) of Medicaid fraud related to your preventive health care practice, we invite you to get in touch. To speak with a senior federal healthcare fraud defense lawyer at Oberheiden P.C., please call 888-680-1745 or contact us online today.