Medicaid Fraud Investigation Process and Penalties

Medicaid Fraud Investigation Process and Penalties

Medicaid provider fraud is among the most prominent frauds in the health care sector. In the United States, for the investigation and prosecution of fraud, there are highly-trained specialized law enforcement groups that concentrate on carrying out investigations related to Medicaid fraud. This team examines the Medicaid providers who bill Medicaid for health products and services.

The Medicaid audit of provider billing in adverse conditions leads to the state or federal investigation. These investigations can result in civil or criminal litigation that can have a detrimental impact on a provider’s life, financial penalties, freedom, and career.

If you are a health care provider that serves Medicaid patients, you must understand the processes and penalties surrounding Medicaid fraud and how working with an aggressive healthcare fraud defense attorney can help you beat wrongful charges.

How the Investigation Process Works

Medicaid is a program that is administered by the states while utilizing federal funding and oversight. The Medicaid Fraud Control Units also referred to as MFCUs, are state-leveled law enforcement agencies. Forty-nine states, as well as the District of Columbia, have their own MFCUs. Many of these units are part of the state’s attorney general’s office.

MFCUs are charged with the duty to identify and prosecute violations of all applicable state laws surrounding the provision of medical assistance as well as the activities of providers under Medicaid plans in each state. MFCU investigations involve:

  • Incidents of billing fraud involving Medicaid
  • The abuse and neglect of residents at nursing homes and other facilities that receive Medicaid payments
  • The misappropriations of patient funds by facilities

These units are responsible for investigating doctors, pharmacies, DME companies, dentists, hospitals, nurses, home health agencies, and various other providers. Patients are not investigated unless they are identified as having conspired with providers to commit Medicaid fraud.

MFCU teams are composed of investigators, attorneys, and auditors. The MFCU and state Medicaid program is unique in design but carries the common goal of investigating improper billing. The state has no control over the MFCU, and these units are not in a position to investigate any fraud within the Medicaid program itself. Instead, they work with state Medicaid program integrity offices to identify and recover payments. The state program has to refer to all cases of supposed fraud to the MFCU.

Medicaid Fraud Penalties and Crimes

Medicaid Fraud Control Units are unique because their investigations can lead to criminal prosecutions and civil lawsuits. When the evidence collected in a fraud investigation is weak, the MFCU may refer the matter to the integrity office at the state Medicaid program to collect overpayments.

Working with a Strong Criminal Defense Attorney is In Your Best Interest

Medicaid fraud is a serious offense and punishable under law. If found guilty, you may face severe consequences that can change your life forever. The law is complex and difficult for conventional people to navigate. If you are accused of Medicaid fraud, you must pursue legal counsel to make sure your rights are safeguarded. The national federal criminal defense law firm represents those who have been accused of healthcare fraud and provides the best possible service to achieve the result.

Our team at Healthcare Fraud Group has extensive experience helping those accused of healthcare fraud cases across the nation. We have the proven record of beating their charges and providing the justice they deserve. If you have been accused of Medicaid fraud, contact our team today at 888-402-4054 to explore the legal options available to you.

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