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Medicare Fraud Lawyers


Medicare Fraud Lawyers: Protecting Providers and Patients

Medicare fraud is a complex issue that impacts healthcare providers, patients, and the healthcare system as a whole. As a healthcare provider, facing an investigation or charges can be scary. My goal with this article is to break down the key things you need to know in a simple, easy-to-understand way.

What is Medicare Fraud?

In simple terms, Medicare fraud refers to intentionally submitting false claims to Medicare for services or treatments that were never provided. Some common examples include:

  • Billing for services that were never performed
  • Misrepresenting a patient’s condition to justify unnecessary tests or procedures
  • Accepting kickbacks for patient referrals
  • Waiving copays or deductibles, which is illegal under Medicare rules

Prosecuting Medicare fraud has become a top priority for the government in recent years. The penalties can be severe, including huge fines, exclusion from Medicare, and even criminal charges.

That’s why having an experienced legal team on your side is so critical if you find yourself under investigation.

Why Me? Common Triggers for Medicare Fraud Investigations

As a healthcare provider, you may feel shocked if you receive notice that you are being investigated for Medicare fraud. After all, you were just trying to treat your patients to the best of your abilities.

It’s important to understand the common triggers that spark these investigations in the first place:

  • Coding errors – Simple billing mistakes can sometimes look suspicious and trigger audits.
  • Complaints – Disgruntled employees or patients lodging complaints can prompt investigations.
  • Data mining – With advanced data analysis, regulators can spot anomalies that seem like fraud.
  • Whistleblowers – Employees reporting suspected fraud is one of the most common triggers.

Mistakes happen in any business – but in healthcare, those errors carry significant risks if they catch the government’s attention.

Having an experienced legal team to represent you is critical to show regulators that errors were just that – unintentional mistakes rather than purposeful deception for profit.

Penalties for Medicare Fraud

The penalties for a Medicare fraud conviction can be severe. You may face:

  • Prison time
  • Huge fines – sometimes totaling millions
  • Exclusion from Medicare/Medicaid
  • Loss of medical license

Even just being under investigation can destroy careers and reputations. These cases can drag on for years, draining massive resources for legal defense fees.

Having skilled legal counsel from the start is key to resolving your case efficiently and preserving your freedom, career and reputation.

Assembling the Right Legal Team

Facing a Medicare fraud investigation can feel terrifying and isolating. But you don’t have to endure this alone.

As you research defense attorneys, prioritize lawyers with extensive experience specifically with Medicare fraud cases. Ask pointed questions like:

  • How many Medicare fraud cases have you handled in your career?
  • What was the outcome of those cases for your clients?
  • Can you share Medicare fraud case results you’ve achieved?

Look for lawyers that have achieved full dismissal of charges, no penalties, and kept healthcare providers out of prison in past cases.

You need an attorney who understands the complex web of regulations and knows how to strategically defend you. For example, we handled a client accused of fraudulent home health certifications. We proved our client qualified for a delegation exception, making the certifications legal. Case dismissed!

An experienced Medicare fraud lawyer can analyze your unique situation to build a customized defense focusing on the exceptions and nuances in the law that apply to your specific case.

The Investigation and Defense Process

Facing legal charges is scary, but understanding the typical stages can help you know what to expect:

Investigation Phase

  • Document/data requests
  • Interviews/questioning
  • Site visits
  • Audits

This pre-charge phase can last months or even years as prosecutors assemble evidence.

Defense Strategy

An experienced attorney will craft a defense by:

  • Thoroughly analyzing the prosecution’s approach
  • Identifying holes in their argument
  • Determining applicable defenses
  • Developing defense witnesses/experts

Litigation Phase

If charges are filed, your legal team will:

  • File motions contesting charges
  • Represent you in court proceedings
  • Negotiate with prosecutors
  • Take your case to trial if necessary

At every phase, an experienced lawyer’s #1 focus is getting charges dropped or securing a “no penalty” resolution to protect your freedom and career.

There is Hope!

Getting that terrifying target letter or subpoena can feel like your career is over. But there is hope! We’ve helped countless healthcare providers emerge from Medicare fraud investigations with their careers, reputations and freedom intact.

With the right legal team fighting on your behalf, you CAN survive a Medicare fraud case. Call our office today for a free case evaluation. We can help you understand your rights, build an aggressive defense, and give you hope for a positive outcome.

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