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Fighting Medicare Fraud Charges: When to Hire a Healthcare Fraud Defense Attorney

Fighting Medicare Fraud Charges: When to Hire a Healthcare Fraud Defense Attorney

Medicare fraud is a serious issue that costs taxpayers billions of dollars each year. Healthcare providers accused of defrauding Medicare face severe penalties, including hefty fines, exclusion from federal healthcare programs, and even criminal prosecution. If you’ve been accused of Medicare fraud, hiring an experienced healthcare fraud defense attorney is crucial to protect your rights and livelihood. Here’s what you need to know about fighting Medicare fraud charges and when to call a lawyer.

What is Medicare Fraud?

Medicare fraud refers to intentionally deceiving Medicare by 1:

  • Billing for services that were never provided
  • Billing for unnecessary services
  • Misrepresenting services provided or diagnoses to increase reimbursements
  • Accepting kickbacks for patient referrals
  • Waiving copays or deductibles
  • Upcoding or unbundling charges
  • Falsifying cost reports

Even unintentional billing errors can be considered fraud if they are excessive or systematic.

Why is Medicare Fraud Prosecuted So Aggressively?

The government takes Medicare fraud very seriously for a few key reasons 2:

  • Cost to taxpayers – Medicare fraud costs taxpayers an estimated $60 billion each year. Prosecuting fraud helps recover some of these losses.
  • Integrity of the system – Medicare fraud threatens the financial stability and integrity of federal healthcare programs. Aggressive prosecution acts as a deterrent.
  • Patient harm – Some types of fraud, like providing unnecessary medical services, can harm patients. Prosecution aims to protect patients.
  • Illegal profits – Healthcare fraud can generate huge ill-gotten profits for perpetrators. Prosecution helps prevent unjust enrichment.

What are the Consequences of Medicare Fraud?

The consequences for Medicare fraud can be severe 3:

  • Civil fines – The federal False Claims Act imposes civil penalties between $11,803 and $23,607 per false claim, plus three times the amount of damages to the government.
  • Criminal fines – Criminal convictions can result in fines up to $100,000 per violation for individuals or $500,000 per violation for organizations.
  • Exclusion – Providers convicted of fraud may be excluded from participating in Medicare, Medicaid, and other federal healthcare programs.
  • Imprisonment – Medicare fraud may be prosecuted as a federal crime with up to 10 years in prison per offense.
  • Loss of license – Criminal convictions can result in loss of medical or other professional licenses.
  • Reputational damage – Fraud allegations and charges can severely damage professional reputations, even if charges are eventually dropped.

When Should I Hire a Healthcare Fraud Defense Attorney?

If you’re being audited or investigated for Medicare fraud, or if you’ve been formally accused, it’s critical to hire an attorney immediately to protect your rights. Here are some signs it’s time to call a lawyer 4:

  • You receive a subpoena for medical records or documents.
  • Investigators contact you requesting an interview.
  • Your business is subjected to an unannounced site visit or raid.
  • You receive notice you’re being excluded from federal healthcare programs.
  • You are charged with fraud by the Department of Justice.
  • A whistleblower files a False Claims Act lawsuit against you.

Don’t wait until charges are filed. By that point, the government may already have built a strong case against you. Engaging counsel early allows you to get out ahead of the investigation.

Christine Twomey
Christine Twomey
Just had my Divorce case settled 2 months ago after having a horrible experience with another firm. I couldn’t be happier with Claire Banks and Elizabeth Garvey with their outstanding professionalism in doing so with Spodek Law Group. Any time I needed questions answered they were always prompt in doing so with all my uncertainties after 30 yrs of marriage.I feel from the bottom of my heart you will NOT be disappointed with either one. Thanks a million.
Brendan huisman
Brendan huisman
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
Keisha Parris
Keisha Parris
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko Beauty
Taïko Beauty
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
Anthony Williams
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
Loveth Okpedo
Loveth Okpedo
Very professional, very transparent, over all a great experience
Bee L
Bee L
Amazing experience with Spodek! Very professional lawyers who take your case seriously. They treated me with respect, were always available, and answered any and all questions. They were able to help me very successfully and removed a huge stress. Highly recommend.
divesh patel
divesh patel
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.

How Can a Healthcare Fraud Lawyer Defend Me?

An experienced healthcare fraud defense attorney can be your best asset in fighting Medicare fraud accusations. Here are some of the ways a knowledgeable lawyer can defend you 5:

  • Conduct an internal investigation – Your attorney can perform an objective internal investigation to determine whether fraud actually occurred and strengthen your defense.
  • Negotiate with prosecutors – Your lawyer may be able to negotiate with prosecutors to reduce charges or penalties through a deferred prosecution agreement or other resolution.
  • Challenge the government’s evidence – Skilled attorneys scrutinize the prosecution’s documents and data analysis to find flaws in their case and develop counter-arguments.
  • Raise affirmative defenses – Affirmative defenses like good faith efforts to comply with regulations can defeat fraud allegations. Your lawyer can argue you acted reasonably.
  • File motions – Your attorney can file motions to have evidence or charges dismissed due to lack of evidence, procedural errors, or other issues.
  • Take your case to trial – If necessary, an experienced trial lawyer can take your case to court and argue for acquittal before a judge or jury.

How Do I Choose the Right Healthcare Fraud Lawyer?

Not all attorneys have the skills and experience to take on Medicare fraud cases. When researching lawyers, look for these key qualifications:

  • Specialization in healthcare fraud defense – Choose a lawyer who focuses specifically on these complex cases.
  • Relevant experience – Find an attorney with a proven track record of favorable outcomes in Medicare fraud cases.
  • Knowledge of healthcare regulations – Your lawyer should have an in-depth understanding of Medicare and Medicaid rules and billing procedures.
  • Trial experience – If your case may go to trial, your lawyer should have litigation and courtroom experience.
  • Resources to take on the government – The government devotes substantial resources to prosecuting fraud. Choose a law firm with the time and capabilities to match.
  • Objectivity – Select a lawyer who will give you an honest assessment of your case, not just tell you what you want to hear.

Don’t let allegations of Medicare fraud go unanswered. With so much at stake, hiring the right attorney quickly is critical to protecting your freedom, reputation, and livelihood. An experienced healthcare fraud lawyer can often get charges reduced or dismissed – but you need their expertise in your corner fighting for you.












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