Medicaid Transportation Coverage Fraud Defense

Medicaid Fraud Defense Counsel Representing Medical Transportation Providers Nationwide

Under the federal regulations that govern Medicaid, state Medicaid programs are required to “assure necessary transportation” to program beneficiaries. Unfortunately, due to widespread fraud, transportation companies that provide non-emergency medical transportation services have come under increasing scrutiny in recent years. Along with audits conducted by contractors working with the Centers for Medicare and Medicaid Services (CMS), this includes Medicaid fraud investigations that can present risks for civil or criminal penalties.

Since Medicaid is a taxpayer-funded program, these audits and investigations largely focus on recouping fraudulent payments. However, targeted medical transportation providers can face additional penalties as well. In addition to recoupments, providers accused of submitting claims in non-compliance with the Medicaid billing regulations can face fines, prepayment review, loss of Medicaid eligibility, and even federal prison time in some cases.

Medicaid Nonemergency Medical Transportation (NEMT) Providers Must Strictly Comply with All Applicable Federal and State Requirements

While non-emergency medical transportation (NEMT) companies provide an essential service to Medicaid recipients, these companies must strictly comply with all applicable federal and state requirements. Those that don’t can face high-risk scrutiny. This includes scrutiny from:

• CMS’s fee-for-service audit contractors
• State Medicaid Fraud Control Units (MFCUs)
• U.S. Department of Health and Human Services Office of Inspector General (HHS OIG)
• U.S. Department of Justice (DOJ)
• Various other federal and state agencies

Our lawyers defend NEMT providers that are facing audits and criminal investigations nationwide. We have extensive experience in this area, and we rely on this experience to protect our clients by all means available.

Types of Cases We Handle

Within our Medicaid fraud defense practice, we represent medical transportation companies and other entities involved in the federally funded health care system in all types of cases. We regularly provide defense representation for matters including:

Medicaid Billing Audits

Medicaid billing audits can present substantial risks for entities that are unprepared. When facing an audit, ensuring that you have proper documentation on-hand is key—as targeted entities must be prepared to affirmatively demonstrate compliance in order to avoid unnecessary consequences.

Medicaid Fraud Investigations

From paying illegal referral fees to claiming to have provided transportation to medical appointments that never took place, Medicaid fraud investigations can target a wide range of allegations. We represent NEMT providers that are facing allegations of all forms of fraudulent activity.

Civil Enforcement Actions

Medical transportation providers that are accused of improperly billing Medicaid can face steep civil penalties. As noted above, these can include recoupments, fines, prepayment review, and loss of Medicaid eligibility, among others. While we target civil settlements with the government on behalf of our clients when warranted, we also seek to help our clients avoid liability whenever possible.

Federal Criminal Cases

We represent individuals and entities in federal criminal cases as well. If your company is facing allegations of intentional Medicaid fraud or abuse, you could be facing federal prison time and other consequences. From New York to California, we handle high-stakes federal cases nationwide, and our former federal prosecutors are intimately familiar with all aspects of the process.

We provide Medicaid compliance representation as well. If necessary, after defending your company in the matter at hand, we can assist your company with developing and implementing a custom-tailored compliance program. Our lawyers have extensive experience working with Medicaid providers to help them maintain and document compliance, and we are intimately familiar with the compliance requirements that apply to NEMT providers.

Common Allegations Against NEMT Service Providers

Medical transportation providers that are facing scrutiny from auditors, federal investigators, or federal prosecutors can face a wide range of allegations. Medicaid fraud can take many forms, and all forms of fraud can expose targeted providers to the risk of facing civil or criminal enforcement action. Some examples of the most common allegations we see in relation to NEMT services include:

• Submitting fraudulent claims for Medicaid reimbursement (i.e., billing for trips that never occurred)
• Billing separately for transportation services provided to groups of Medicaid beneficiaries
• Billing for NEMT services provided to ineligible patients (i.e., non-Medicaid patients)
• Failure to comply with the Medicaid requirements regarding provider eligibility
• Double-billing, upcoding, and other fraudulent practices under the Medicaid program

Again, these are just some of the most common examples. When facing scrutiny, it is critical to ensure that you have a clear and comprehensive understanding of the risks your company is facing. It is critical to ensure that you are prepared to defend your company (and potentially yourself) to the fullest extent possible as well.

What To Do if Your NEMT Business if Facing a Medicaid Audit, Federal Investigation, or Allegations of Defrauding Medicaid

With this in mind, if your business is facing a Medicaid audit, federal investigation, or allegations of defrauding Medicaid, there are some important steps you should take promptly. These steps include (but are not limited to):

• Preserve Your GPS Data and Trip Logs – When facing NEMT-related Medicaid audits and investigations, GPS trip verification data and trip logs can be key for proving that trips occurred. You should preserve all relevant GPS data and trip logs.
• Preserve Your Medicaid Billing Records and Other Relevant Documentation – Any documentation you have on hand could be critical to your company’s defense. Conversely, destroying records, even in the ordinary course of business, will raise red flags.
• Avoid Improperly Billing Medicaid for NEMT Services – When facing Medicaid-related scrutiny, it is critical to avoid improperly billing Medicaid. If you aren’t sure whether your company’s billing practices are compliant, our lawyers can help.
• Engage Experienced Medicaid Fraud Defense Counsel – In all scenarios, experienced legal representation is required. Targeted medical transportation companies should engage experienced Medicaid fraud defense counsel promptly.
• Work with Your Defense Counsel to Assess Your Risk and Develop a Strategy – Assessing your risk will involve conducting an internal Medicaid compliance audit with your defense counsel’s oversight. After conducting this assessment, you should work with your defense counsel to formulate and execute a targeted defense strategy.

FAQs: Defending Against Allegations of Medicaid Transportation Coverage Fraud

Speak with a Medicaid NEMT Fraud Defense Lawyer at Oberheiden P.C.

If you need to know more about the risks involved in facing Medicaid-related scrutiny or what you can (and should) be doing to avoid unnecessary consequences, we encourage you to contact us promptly. To speak with an experienced Medicaid NEMT fraud defense lawyer in strict confidence as soon as possible, call 888-680-1745 or tell us how we can reach you online now.