Medicaid Reentry Services Fraud Defense

We Represent Medicaid Reentry Service Providers that Are Facing Accusations of Fraud

Healthcare providers and other businesses that offer reentry services to formerly incarcerated individuals play a critical role in society. These are essential services for individuals who need to reintegrate following their time in prison—and who need help during the process.

But, due to widespread fraud, these providers are now facing intensive scrutiny from auditor contractors working for the Centers for Medicare and Medicaid Services (CMS), the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), and other authorities. If your practice or business is facing scrutiny related to its billings under the Medicaid program, our lawyers can help.

Common Healthcare Fraud Allegations Against Reentry Service Providers

Our lawyers defend Medicaid providers, case management providers, urine drug screening companies, and other clients accused of defrauding the federally funded healthcare system. We handle audits, criminal investigations, and enforcement proceedings—including those that present risks for federal prison time.

Providers and other entities targeted in these cases can face a wide range of allegations. Our defense team has experience defending clients accused of all forms of fraud; and, since several of our lawyers are former federal prosecutors, we are familiar with the billing patterns and other issues that are likely to raise red flags.

Some examples of common allegations against reentry service providers in Medicaid audits, investigations, and civil and criminal enforcement proceedings include:

• Offering, paying, soliciting, or accepting illegal kickbacks in exchange for referrals
• Billing Medicaid for ineligible services (i.e., medically unnecessary services) provided to people returning to society after spending time in jail
• Making false statements or using falsified documentation to support fraudulent claims for Medicaid benefits
• Submitting false information to the government in order to establish eligibility for Medicaid reimbursement
• Defrauding Medicaid and then using or misappropriating taxpayer dollars for personal gain

Auditors working for CMS, the HHS OIG, the U.S. Department of Justice (DOJ), and other authorities are aggressively targeting all forms of fraud, waste, and abuse under Medicaid. While these efforts are intended to protect patients and taxpayers, aggressive enforcement often leads to unwarranted consequences for compliant and well-intentioned providers. With this in mind, if you are facing scrutiny from auditors or investigators, it will be important for you to promptly engage experienced defense counsel regardless of the circumstances at hand.

Potential Defense Strategies for Medicaid Fraud Audits and Investigations

Providers targeted in Medicaid audits and investigations can face recoupments, treble damages, fines, prepayment review, loss of Medicaid eligibility, and other penalties. They can also face federal criminal charges in some cases. As a result, an informed and effective defense strategy is essential. While building an informed and effective defense strategy requires a thorough assessment of the circumstances at hand, some examples of potential defense strategies for Medicaid fraud audits and investigations targeting reentry service providers include:

• Conducting an Internal Medicaid Billing Compliance Assessment – In all cases, targeted reentry service providers should promptly engage counsel to conduct an internal Medicaid billing compliance assessment. Our lawyers can work with your Medicaid director and/or other relevant personnel to efficiently assess the risks at hand.
• Affirmatively Demonstrating Medicaid Billing Compliance – For many providers, avoiding penalties will involve affirmatively demonstrating Medicaid billing compliance. If you can use records you have on hand to show that your business has properly billed Medicaid for providing access to services focused on successful care transitions and reentry outcomes as authorized by law, you should not be at risk of facing additional liability.
• Challenging Flaws and Overreach During Audits and Investigations – Flaws and overreach during Medicaid coverage audits and Medicaid fraud investigations are not uncommon. If your business is facing scrutiny, our lawyers can scrutinize the auditors’ or federal agents’ practices and help ensure that your business is not penalized unfairly.
• Targeting a Settlement that Preserves Medicaid Eligibility (When Warranted) – If your business has improperly billed Medicaid, it may make sense to target a civil settlement with the government. If it is in your business’s best interests to settle, our lawyers can target a settlement that both minimizes your business’s financial liability and preserves its Medicaid eligibility.
• Preparing to Fight Medicaid Fraud Allegations in Court (When Necessary) – Our lawyers can also prepare to fight Medicaid fraud allegations in federal court if necessary. From improperly billing Medicaid to failing to file federal tax returns (or filing false returns), reentry services providers targeted for federal prosecution can face a wide range of serious allegations. We have successfully represented numerous clients in the federal justice system, and we can rely on our experience to help protect you.

To find out what you can—and should—be doing to protect your business (and potentially yourself), contact us today. Our experienced Medicaid fraud defense lawyers can help you make informed and strategic decisions about your next steps, and we can provide legal representation on an emergency basis if necessary.

We Represent Reentry Service Providers in Medicaid Fraud Cases Nationwide

As a healthcare fraud defense law firm, we represent reentry service providers in Medicaid fraud cases nationwide. We have extensive relevant experience—including prior experience as federal healthcare fraud prosecutors—and we rely on this experience to protect our clients by all means available.

While many formerly incarcerated individuals who have substance use disorders and other mental and physical health conditions rely heavily on reentry services, reentry service providers have faced intensive scrutiny in recent years. We are committed to ensuring that the businesses and people involved in providing these services do not face unnecessary and unwarranted consequences.

Our clients range from small businesses and physician-owned practices to companies that have received millions in Medicaid funds. We take a custom-tailored approach to every case we handle, and we do everything we can to help our clients avoid restitution liability, loss of their ability to bill Medicaid, and other serious penalties.

FAQs: What to Know When Facing Allegations of Health Care Fraud Under Medicaid

Schedule a Free, No-Obligation Consultation with a Medicaid Reentry Services Fraud Defense Lawyer at Oberheiden P.C.

If you need to speak with an experienced Medicaid defense lawyer, we invite you to get in touch. To schedule a free and confidential consultation with one of our senior defense lawyers as soon as possible, call us at 888-680-1745 or tell us how we can contact you online now.