Providers that are suspected of Medicaid fraud can face civil and criminal charges. It’s important to understand that the process of a Medicaid fraud case progresses much faster than many other legal matters. It’s imperative that you contact a Philadelphia Medicaid fraud lawyer as soon as possible.
Medicaid Fraud Cases
Cases of Medicaid fraud are typically assigned to a special prosecutor with expertise in fraud laws. This is a key reason why you must hire a lawyer that has experience handling Medicaid fraud cases. Audits for suspected Medicaid fraud are performed by state agencies to determine whether the provider is in compliance with program requirements. They look for possible overpayments and any evidence of fraud. In many cases, a Medicaid fraud audit is conducted due to a complaint filed by a patient, Medicaid plan or whistleblower.
A desk audit is often conducted, which is when officials audit onsite and offsite records. There are various methods used to detect overpayment. Some of the most common methods include the evaluation of claims across a specific region and data mining of claims to pinpoint outliers. In the event that an auditor suspects a provider of fraud, they will notify the Medicaid Fraud Control Unit.
Some of the most common types of Medicaid fraud include billing for services or equipment not provided, false invoicing, billing unbundled services and the overutilization of medical procedures. It’s possible that an audit will result in false claims charges, overpayment demands and anti-kickback actions, among other consequences.
Medicaid Fraud Defenses
A Philadelphia Medicaid fraud lawyer can work closely with you to prepare for an investigation or audit. An experienced lawyer will work with the state authorities assigned to the case during the actual investigation for the purpose of protecting your rights and interests. It is important that you understand the process, including the information that must be submitted during an investigation. It’s critical that you submit a sufficient amount of information to defend yourself against the claims.
A Philadelphia Medicaid fraud lawyer can help guide you through the process so that you understand what should be submitted to prevent overpayment demands. A lawyer can work on your behalf to prevent the state from filing criminal charges. They will also endeavor to prevent overpayment and licensing actions against you. The goal is to minimize the impact that a Medicaid fraud claim has on your career and life.
A Philadelphia Medicaid fraud lawyer will examine the facts of the case to develop a strong defense, which could result in having the case dismissed. Medicaid fraud can potentially result in a criminal indictment, in addition to a state professional licensing and civil complaints. The consequences can be long-term, possibly resulting in fines, license suspension or revocation, and even jail time as a result of criminal charges. Other possible consequences include loss of staff privileges, expulsion from the Medicaid program and being unable to collect on outstanding invoices.
An experienced lawyer will work on your behalf to mitigate a potentially devastating outcome that can severely impact your career and standing in the community. Given the devastation that a Medicaid fraud charge can cause, an experienced lawyer should be obtained at your earliest opportunity. The results of a Medicaid fraud claim could affect the rest of your life. The ultimate goal is to achieve the most favorable outcome possible.