If you are a health care practitioner, the mere accusation of Medicaid or Medicare fraud can negatively impact your career and professional reputation. A conviction for fraud can, of course, be much worse, with penalties including a hefty fine, loss of your medical license, and even incarceration.
If you are under investigation for, or have been formally charged with, Medicaid or Medicare fraud, you need a federal trial attorney who will zealously defend you and your rights. At Haas Law, we have extensive experience representing health care professionals and organizations accused of Medicaid and Medicare fraud and will mount a strong defense to protect your rights and your future.
What Is Medicaid Fraud?
According to the Center for Medicaid and Medicare Services (CMS), Medicaid fraud is “the intentional providing of false information to get Medicaid to pay for medical care or services.” Common examples of Medicaid fraud when perpetrated by a health care professional include:
- Billing for services or equipment that are not necessary
- Billing for nonexistent services or equipment
- Overutilization of certain medical procedures or services
- Upcoding — billing at a higher level than the services justify
- Unbundling — using multiple billing codes when one code is sufficient
- Billing for the same treatment multiple times
- Card sharing — knowingly treating someone who is using someone else’s Medicaid card
- Kickbacks — paying or accepting money, or something else of value, for patient referrals
What Is Medicare Fraud?
The Center for Medicaid and Medicare classifies conduct that constitutes Medicare fraud into one of the following three categories:
- False claims and misrepresentations — knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to obtain a Federal health care payment for which no entitlement would otherwise exist.
- Kickbacks — knowingly soliciting, receiving, offering, or paying remuneration (e.g., kickbacks, bribes, or rebates) to induce or reward referrals for items or services reimbursed by Federal health care programs.
- Referrals — making prohibited referrals for certain designated health services
Laws and Penalties Governing Medicaid and Medicare Fraud
There are several complex federal laws that apply to Medicaid and/or Medicare fraud, with harsh penalties for violations. Each case is different, but, in general, the laws and penalties governing Medicaid and Medicare fraud are:
- False Claims Act (FCA)— Any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government may face civil liability under the FCA. Specifically, you may be required to pay up to three times the amount of damages sustained by the Government as a result of the false claims, plus penalties up to $22,927 per false claim filed (as of 2019).
- Anti-Kickback Statute (AKS) — It is a crime to knowingly and willfully offer, pay, solicit, or receive any remuneration directly or indirectly to induce or reward patient referrals or the generation of business involving any item or service reimbursable by a Federal health care program. If convicted, you face fines of up to three times the amount of the kickback, plus up to $100,000 per kickback (as of 2019), imprisonment, and exclusion from participation in the Federal health care program.
- Physician Self-Referral Law (Stark Law) — A physician is prohibited from referring patients to an entity with which the physician or a member of the physician’s immediate family has a financial relationship for “designated health services” payable by Medicare or Medicaid. A violation of the Stark Law could result in fines of up to $24,478 for each service, repayment of claims, and potential exclusion from participation in the Federal health care programs.
Defending Against Medicaid and Medicare Fraud Charges
The U.S. Attorney’s Health Care Fraud Division takes Medicaid and Medicare fraud very seriously. They aggressively investigate and prosecute doctors and other health care providers, using every resource available, including confidential informants, such as patients, previous employees, and colleagues. If you are being investigated, you need an aggressive federal defense attorney to fight for your rights and protect your future.
As a former federal prosecutor, Attorney David Haas knows how federal investigations and negotiations work. Moreover, he understands the federal court system and knows how to uncover weaknesses in the prosecution’s case. For example, the government’s witnesses might not be credible; the government’s investigation might have missed some pertinent information; or investigators might have mistaken errors for fraud.
Whatever the case may be, Attorney Haas will use put his knowledge of the law and federal trial experience to work finding and fighting for the best resolution for you and your future.
Get Help from an Experienced Federal Medicaid/Medicare Fraud Defense Attorney
If you are being investigated for Medicaid/Medicare fraud, or if charges have already been filed against you, the key to limiting the negative ramifications for your career, your family, and your future is to retain Attorney David Haas as soon as possible. Please do not talk to prosecutors, colleagues, or friends without first consulting with us, so we can make sure your rights are protected.
When you are facing federal criminal charges, it is important to have a criminal defense attorney with years of experience in federal court. At Haas Law, we have tried dozens and dozens of cases in federal court, always fighting aggressively for clients’ rights and freedom. We are committed to putting our extensive experience with federal investigations and prosecutions to work for you to ensure the best possible outcome.
Call us at 407-755-7675, chat with us online, or submit our online form today. We understand that time is of the essence when federal law enforcement authorities are investigating you, so our calls are answered 24 hours a day.