Being accused of Medicaid fraud is a serious legal matter. Investigations often begin with a letter from a Medicaid investigator asking for you to turn over documents and set up a time for an “interview.”
BE WARNED; this is not an interview and providing documents without having a Medicaid fraud attorney review them is a big mistake. It is time to call me, an experienced Medicaid Fraud Lawyer. If you make the error of going in alone its already too late, the investigator has already gathered evidence against you, and they already suspect that you are guilty of wrongdoing.
Important note, anything you say at this point may be used against you in a future criminal proceeding. Do not try to handle this on your own. I can work with the authorities to clear up any inconsistencies and misunderstandings. I will work to get you the best results possible. Many times I have been able to work out settlements that allow my clients to keep their medical licenses and avoid jail time. Contact me, an experienced Medicaid fraud lawyer.
5 Points to Ease Your Worry if Being Investigated
First, determine why you are being investigated
The following are red flags that may trigger a Medicaid fraud investigation
- an unusually high number of Medicaid claims
- a computer-generated analysis of Medicaid claims and billing codes
- an anonymous call to a Medicaid fraud hotline
- a whistleblower who hopes to get a financial reward
Second, know your rights
Your rights are as follows:
- You have the right to bring an attorney to any interviews with investigators.
- You also have the right to consult with your lawyer before providing any documentation or answering any questions.
- You have the right to remain silent.
- If you are a Medicaid recipient, your benefits cannot be stopped solely because you refuse to cooperate.
Third, know what the possible penalties are
Penalties for Medicaid fraud can be as relaxed as repayment or as severe as lengthy prison sentences. Some of the possible consequences include:
- monetary fines, penalties, and restitution orders
- disqualification from receiving Medicaid benefits
- civil judgments and liens on any real property you own
- garnishment of your wages
- criminal prosecutions and a possible prison sentence
- suspension or loss of professional licenses
- exclusion from participating in Medicaid as a provider
- depending on your immigration status, you could be deported
Fourth, understand that you and your attorney can negotiate a settlement with authorities
Getting the best result depends on gathering the best team. I work with CPAs and other attorneys who together help steer the investigation in the direction we need it to go. Many times we will work to secure a financial settlement to avoid any court cases or criminal prosecutions.
In cases where financial settlement is offered and you cannot pay the full amount of the settlement at once, many times we can work out an payment plan. This will ease the burden on you and your family.
The question is not whether you need an experienced Medicaid fraud attorney, it is whether you want the best Medicaid fraud attorney. Don’t risk going with a guy who has to learn as he goes. We can reduce repayments, eliminate penalties and interest, and, most importantly keep you out of prison.
Fifth, conduct an internal evaluation to determine if indeed some level of fraud has been committed
Important: an internal analysis conducted by an attorney is protected and cannot be seen by investigators. This will assist you and your attorney in preparing a case.
Normally, when a medical professional or Medicaid provider is accused of fraud, allegations usually involve billing for services that were not medically necessary, misrepresenting the services provided, or billing for services that were not provided. Proving or disproving these phantom services can be a paper chase. Only an experienced Medicaid fraud attorney can organize these records to prove your case. Common accusations surround the following types of billing:
- billing for services not provided, known as “phantom billing”
- billing for fake or non-existent medical conditions
- billing for services that were not medically necessary
- billing for a more expensive service than was actually rendered, known as “upcoding”
- billing separately for several services that should be billed as a group, known as “unbundling”
- double billing by billing twice for the same service or by billing both Medicaid and a private insurer
- billing for services provided by unlicensed or uncertified personnel in violation of Medicaid rules
- billing for services provided by someone who is on a Medicaid exclusion list
- prescribing or filling fraudulent prescriptions
- illegal fee sharing
- dispensing generic drugs and billing for more expensive brand-name drugs
- giving or receiving something in return for medical services or referrals, known as a kickback
- submitting false time records or price reports
Do not let Medicaid fraud charges tear apart your life and lump you in with wrongdoing that may not be your fault. Don’t let them charge you with the entire pie when you may only be responsible for a single crumb. Call me, a knowledgeable, experienced, and proven fighter; a real Medicaid fraud attorney.