Telehealth Medicaid Fraud Defense

Our Defense Firm Represents Telehealth Providers Facing Federal Fraud Allegations Under Medicaid

Medical professionals and entities that provide Medicaid-reimbursed telehealth services must strictly comply with the Centers for Medicare & Medicaid Services’ (CMS) telehealth regulations. Failure to do so can lead to steep penalties—including criminal penalties in some cases.

The popularity of telehealth and telemedicine services skyrocketed during the COVID-19 pandemic. While restrictions were relaxed to facilitate access to physical and mental health services during the pandemic, federal authorities are now vigorously enforcing strict compliance.

This poses substantial risks. Noncompliance with the federal telehealth regulations can expose providers to steep civil penalties. Targeted providers can also face criminal penalties in some cases. As a result, for those that are facing scrutiny from the U.S. Department of Justice (DOJ) or U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), executing an informed and strategic defense is critical for avoiding unnecessary consequences.

Common Allegations in Telehealth Medicaid Fraud Cases

We defend telehealth providers, telemedicine companies, billing companies, Medicaid managed care organizations (MCOs), and other clients against all types of telehealth-related fraud allegations under Medicaid and other federal programs. Our team has extensive experience in this area, and we handle investigations and prosecutions involving all types of alleged fraud.

Federal authorities are targeting entities in the telehealth sector for all types of fraudulent practices related to Medicaid-reimbursed services, equipment, medications, and supplies. Some of the most common allegations we are seeing in these cases include:

• Medicaid billing fraud (i.e., upcoding, unbundling, and submitting duplicate claims)
• Submitting false documentation or making false statements relating to providers’ fraudulent Medicaid billings
• Durable medical equipment (DME) fraud under Medicaid
• Billing Medicaid for behavioral health services and other medical services that lack medical necessity (billing for medically unnecessary services)
• Paying unlawful kickbacks or referral fees to telemedicine providers and other health care providers
• Billing multiple Medicaid programs or double-billing Medicaid and other federal healthcare programs or private payors
• Other improper billing practices that amount to telehealth fraud or telemedicine fraud under CMS’s rules and regulations

These allegations (among many others) can pose serious risks for entities and individuals accused of improperly billing for telehealth and telemedicine services under the Medicare and Medicaid programs. Depending on the circumstances involved, healthcare providers and others facing these allegations can be charged with:  

False Claims Act Violations

The False Claims Act is one of the government’s most potent weapons in federal healthcare fraud investigations. It prohibits Medicaid providers (and other entities and individuals) from submitting any “false or fraudulent claims” for reimbursement, and it includes provisions for both civil and criminal penalties. False Claims Act cases are easily among the most common types of cases we handle within our healthcare fraud defense practice.

Anti-Kickback Statute Violations

The Anti-Kickback Statute prohibits entities and individuals across the health care industry from paying referral fees and other forms of remuneration out of Medicaid-reimbursed funds. While Anti-Kickback Statute violations are commonly uncovered during Medicaid audits, they can lead to criminal charges in some cases. If Medicaid auditors or federal investigators are looking into your business’s or practice’s payment or receipt of alleged kickbacks, you should consult with a telehealth Medicaid fraud defense lawyer promptly.

Stark Law Violations

The Stark Law applies specifically to physicians and their related entities. Stark Law violations are civil in nature—though they can also implicate the False Claims Act and Anti-Kickback Statute in many cases. We have extensive experience representing healthcare professionals in Stark Law cases; and, if you are facing allegations of engaging in so-called “physician self-referrals,”  our team of experienced attorneys can defend you by all means available.

Healthcare Fraud Statute Violations

When federal investigators uncover evidence (or apparent evidence) of criminal intent in telehealth Medicaid fraud cases, prosecutors at the DOJ can use this evidence to pursue allegations under the healthcare fraud statute (18 U.S.C. Section 1347) in federal court. If you are being accused of perpetrating a fraudulent scheme related to billing Medicaid for telehealth or telemedicine services in violation of the federal healthcare fraud statute, you are facing fines and prison time.

We Handle Telehealth Medicaid Fraud Investigations Involving All Federal Agencies

We handle telehealth Medicaid fraud investigations involving all federal agencies. We handle select cases involving Medicaid Fraud Control Units (MFCUs) and other state agencies as well. If you are under investigation (or if your business or practice is under investigation) for improper Medicaid billings related to telemedicine or telehealth services, our lawyers can intervene in the investigative process and work to efficiently steer the inquiry toward a favorable resolution.

We Also Defend Telehealth Providers Facing Medicaid Fraud Charges from Federal Prosecutors

Along with defending clients during Medicaid fraud investigations, we also provide defense representation for clients that are facing Medicaid-related fraud charges in state and federal courts. We have extensive experience in these (and other) health care fraud cases, and several of our defense lawyers handled healthcare fraud prosecutions at the DOJ before entering private practice.

What to Do if You Are Facing Telehealth Medicaid Fraud Allegations from the Federal Government

If you are facing telehealth Medicaid fraud allegations from the federal government (or an MFCU or another state law enforcement agency), there are several important steps you need to take promptly. To protect yourself (and your business or practice), you should:

1. Preserve All Relevant Records

When facing allegations of Medicare fraud or Medicaid fraud, it is imperative to preserve all relevant records. This includes medical records and billing records, among others. Not only can failing to preserve relevant records raise red flags, but this alone can result in an enforcement action in some cases.

2. Avoid Improperly Billing Medicaid or Engaging in Other Unlawful Activity

Telehealth providers and other targets that are facing Medicaid-related scrutiny must be extremely careful to avoid submitting improper reimbursement requests or engaging in any other unlawful activity. Continuing to violate the law while you are under investigation can substantially increase the risks involved.

3. Engage Experienced Medicaid Fraud Defense Counsel

Due to the risks involved in facing telehealth-related scrutiny under Medicaid, engaging experienced defense counsel is essential. Once you find out that an audit or investigation is underway, you should engage an experienced Medicaid fraud defense lawyer as soon as possible.

This list is not exhaustive. Facing Medicaid-related fraud allegations is an extremely serious matter that requires an informed, cautious, and strategic approach. Once you contact us about your matter, we can explain everything you need to know; and, if you are facing a government investigation, we can intervene immediately if necessary.

FAQs: Defending Against Federal Investigations and Charges Involving Medicaid Billings for Telehealth Services

Schedule a Confidential Consultation with a Telehealth Medicaid Fraud Defense Attorney Today

If you need to speak with a telehealth Medicaid fraud defense attorney about an investigation, grand jury subpoena, civil enforcement action, or criminal prosecution, contact us today. Call 888-680-1745 or contact us online to speak with a senior defense attorney at Oberheiden P.C. as soon as possible.