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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.

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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