Medicaid Fraud Attorney

Medicaid Fraud Attorney

Medicaid is health insurance funded by the US federal government to assist individuals with medical needs who can’t provide their own private health insurance. Medicaid receives funding from the Department of Social and Health Services (DSHS) and the Health Care Authority (HCA). Due to the oftentimes unregulated nature of these healthcare services, there several cases of Medicaid fraud that cost the federal government millions of dollars. In Medicaid fraud cases, it is crucial to retain the services of a well-versed and experienced Medicaid fraud lawyer.


Hiring an Attorney for Medicaid Fraud

Though a small portion of Medicaid healthcare providers prey on vulnerable citizens and rightfully deserve punishment, it is unfortunate that other Medicaid healthcare providers get accused of small discrepancies and are faced with extremely large legal ramifications. In such situations, it is extremely important to hire the services of an attorney who is knowledgeable in Medicaid law to safeguard your personal reputation and business livelihood. If facing charges, avoid talking to anyone until you speak with a Medicaid fraud defense attorney. They will be sure to protect your rights throughout the legal process.


Fighting Unfounded Allegations by the Attorney General’s Medicaid Fraud Unit

The government has enacted strict measures to prevent Medicaid fraud. As a result, some medical professionals like pharmacists, doctors, and dentists may experience unwarranted accusations of fraud. One of the only ways to properly defend yourself is by working with an Attorney General’s Medicaid Fraud Unit.

Medicaid fraud involves falsifying information to benefit from reimbursements beyond the actual cost of what services were provided. Several penal codes have been put in place to protect American citizens and punish those who try and defraud Medicaid. Unfortunately, some people get accused of crimes they didn’t commit. Because individuals who work in the medical industry are so reliant on their professional standing, allegations can wreak havoc on a career that took decades to build.

When you discover that you’re under investigation for Medicaid fraud, do not panic. Consult a professional Medicaid fraud defense attorney immediately.


Cases That Medical Fraud Defense Attorney Handle Includes:

1. Phantom Billing

Also known as fraudulent billing, phantom billing occurs when no services were rendered, but a billing form is submitted. In this form of fraud, services get billed even though they never happened. Fraudulent or phantom billing can be a significant problem for medical professionals. Anyone who faces charges of phantom billing should talk to an attorney general’s Medicaid fraud unit as soon as possible have a better chance of enjoying a favorable legal outcome.

2. Upcoding

One of the most popular forms of Medicaid fraud is Upcoding. It occurs when procedures get billed more than they should cost. Because the Medicaid billing process is extremely complex, it is oftentimes hard to detect errors. As a result, an individual in the medical field who committed no crime might get charged with a billing error that could send them to prison. When a doctor or any medical professional gets accused of Medicaid upcoding fraud charges, they should contact a Medicaid fraud lawyer general immediately.

3. Unnecessary Services

Some providers perform unnecessary services that they receive payment for. For any procedure or service to get paid, it should meet Medicaid billing standards. If a process or service is performed that is justified as being unnecessary, then a medical professional may face unnecessary services Medicaid fraud charges. If these charges are brought against any medical professional, the services of an experienced Medicaid attorney should be sought out immediately.

4. Unbundling

When similar procedures are performed together, they come with specific rates and bundling costs. In most cases, the bundled costs and rates total to a lower price. However, when the procedures get separated and billed the overall price increases individually. As a result, unbundling Medicaid fraud happens. If a medical professional finds themselves accused of unbundling, it is crucial to consult the services of a skilled Medicaid fraud lawyer.

5. Kickbacks

Kickbacks are not allowed in the medical profession. When they happen, Medicaid fraud is committed. Kickbacks are secret payments between people working in the medical industry and healthcare providers. A kickback occurs when a hidden payment is offered to a healthcare provider in exchange for using a particular service or medical item. Such cases are common, and medical professionals are frequently accused of such crimes.


What Happens When You Fail to Get a Professional Medicaid Defense Lawyer General?

An unqualified and unexperienced Medicaid fraud defense attorney may lose a case even though their client is innocent. As a result, medical professionals may find themselves facing significant legal consequences. The federal government is stringent on Medicaid charges and charges may end a medical professional’s career. When an individual’s medical practice is accused of Medicaid fraud, their practice is subjected to serious investigations and scrutiny. If the healthcare professional is convicted, they will spend a minimum of five years in a government correctional facility. Also, the fines and fees one is forced to pay as a result of a Medicaid fraud conviction are significant. Some are forced to pay over a million dollars if convicted.

Medicaid fraud accusations happen extremely quickly. If a medical professional fails to get a skilled attorney, they may face both civil and criminal charges associated with Medicaid fraud. Cases dealing with Medicaid fraud are known for progressing quickly and delivering devastating consequences. It is important that Medicaid fraud cases get handled timely and accurately. In the absence of a skilled and knowledgeable Medicaid attorney, healthcare professionals will oftentimes lose a case against them. A lawsuit against a healthcare professional may be initiated by a group of people or an individual. Regardless of who brings the charges, whenever a Medicaid fraud charge is leveled against a healthcare professional, they should quickly retain the services of an experienced Medicaid attorney.


Starting the Investigation on a Medicaid Fraud

Medicaid fraud lawyers file cases based on the False Claims Act on behalf of the provider for the case to commence. An attorney’s fraud unit then serves the government with all the evidence on them. After getting served, the government seeks an interview with the plaintiff’s attorney. It is during the interview that the government asses the plaintiff’s credibility. This interview also gathers information in helping with an investigation.


Medicaid Fraud Investigation Process

As the government investigates during the interview, the case on false claims is examined. The prosecutor handling the case engages the government agency responsible for getting its opinion on the matter. The prosecutor gathers and reviews the government’s claim to estimate the magnitude of the case. It is then that the prosecutor can design a plan on how to investigate the facts.

To probe the facts, the defendants must be issued with a Civil Investigatory Demand (CID) by the government to obtain documents. The government may seek out the defendant and perform an interview or depose the present employees of the defendant. The government may also decide to present the allegations to the defendant and request a response. While doing so, it may not disclose whether the case has gotten filed, and the identity of the plaintiff.


Medicaid Fraud Investigation Settlement

After the government investigates the case on Medicaid False Claims Act, it decides on whether or not to pursue or drop the case. In case the government continues with the case, it serves the defendant with a complaint. Instances where the claim gets declined, or a whistleblower refrains from settling the matter legally, the whistleblower and government voluntarily dismiss the case.

Control Units for Medicaid Fraud

State Medicaid Fraud Control Units (MFCU) get tasked to investigate and prosecute any patient neglect or abuse and Medicaid fraud. The MFCUs also collect or refer a collection of any overpayments that they identify.

Contact Us Regarding Any Case on Medicaid Fraud

Our Medicaid fraud defense attorneys at The Healthcare Fraud Group will advocate aggressively in court on your behalf. Contact us now for a free consultation or call 888-402-4054 on your Medicaid fraud case.