In recent years, a significant amount of time and resources have been dedicated to local governments for the purpose of investigating and prosecuting Medicaid fraud. Subsequently, many providers have been subjected to investigations stemming from billing errors and other discrepancies.
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.
Philadelphia Medicare Fraud Lawyers
The healthcare industry is a very important industry that helps to ensure that all people are able to gain access to healthcare when they need it. One very important participant in this program is Medicare, which is a federal program that helps to ensure that millions of people get the care that they need and deserve. Today, many healthcare providers earn a large portion of their revenue from Medicare for providing important services.
In the majority of situations, a healthcare provider will bill Medicare for charges that are legitimate. However, there are situations in which someone could bill an inaccurate amount. Depending on the situation, this could constitute Medicare fraud.
Examples of Medicare Fraud
The most common type of Medicare fraud occurs when you bill for services that were not performed. If you had a patient come into your practice that you performed certain services for, any additional services that you billed for that were not performed would be considered a fraud. Other examples of this can include if you coded certain services differently to ensure they would either be covered or if they would be reimbursed at a higher amount.
Another serious example of Medicare fraud is if you performed medical procedures and services on someone that did not need the services. If it is determined that you did certain services that were not necessary simply to earn additional revenue, you could be charged with Medicare fraud.
Finally, if you were to accept kickback or bribes for taking certain patients, or for referring them to another specialist, it would be a clear violation of the law and you could be charged with Medicare fraud. This would also include if you paid money to another party in lieu of them referring a patient to your practice in order to boost your revenue.
If you are charged with Medicare fraud, there are a variety of charges that you could be facing as well. Since you likely will receive your Medicare reimbursement either through a check or through a bank wire, you could be charged with mail or wire fraud as well. Both of these can come with serious penalties as well since they are considered felonies and could be investigated by the FBI.
If you are charged with Medicare fraud, there are a variety of penalties that you could be facing. Depending on the scope of the fraud, you could be facing felony charges that would also come with imprisonment. In more minor cases, you could still be facing some significant financial penalties. At a minimum, Medicare will seek to be reimbursed for the amount that was deemed to be fraudulently earned plus expenses. In other situations, you could be billed for additional financial penalties.
For healthcare providers, another concern about Medicare fraud is that it could be very damaging to a business. Depending on the situation, you could end up losing your right to bill for Medicare. This could immediately reduce the amount of customers that you have and would be very damaging to your business. If you happen to have provided care that was considered negligent or not necessary, you could also face losing your medical practice license entirely.
If you are charged with Medicare fraud, ensuring that you have proper legal support is very important. A Medicare fraud attorney can provide you with a variety of services to ensure your rights are represented and that you make the right choices for your situation. An experienced Medicare fraud attorney will be very familiar with the different types of Medicare fraud and how to defend these cases. In many situations, the attorney will be able to work with the other parties to negotiate a lower charge, which could help to drastically reduce the potential penalties that you are facing.