Medicare Fraud Defense Lawyers

Medicare fraud involves knowingly submitting a false claim or making a misrepresentation of facts to obtain payment from the federal healthcare program of Medicare. The charges encompass a wide scope of statutes, and healthcare professionals need an experienced legal team to launch a strong and effective defense. The attorneys at Norman Spencer Law Group are at your service.

Our team of lawyers has more than 10 years’ experience representing and defending licensed healthcare professionals, including providers and suppliers accused of Medicare fraud. We have handled all stages of Medicare fraud cases, from fraud investigations and audits to criminal and civil Medicare fraud actions. Clients have included doctors, pharmacists, chiropractors, urgent care centers, behavioral health facilities, and home healthcare agencies.

Medicare fraud extends to violations of the False Claims Act, Stark laws, anti-kickback and healthcare fraud statutes. One of the most common violations is knowingly submitting a false statement or misrepresenting facts to obtain Medicare payments to which they patient or provider is not entitled.

Medicare fraud can also include knowingly soliciting, accepting or paying remuneration for patient referrals for supplies or services reimbursed by a federal healthcare program, as well as making unlawful referrals for specific designated health services.

Medicare fraud covers an extensive range of violations, and several examples include:

• False claims submitted for CMS payment
• Billing for supplies or services not provided
• Claims submitted for supplies or services for patients that don’t exist, or with whom the provider has no doctor-patient relationship, or ghost patients
• Duplicate billing
• Billing for services of a low enough quality to be deemed virtually worthless
• Billing for durable medical equipment that has not been legitimately prescribed by a physician
• Billing individually for treatments or tests that are bundled under one procedure code and cost, or unbundling
• Billing at a higher procedure code than actually performed, or up-coding
• Performing additional tests or treatments not clinically necessary
• Submitting claims on behalf of providers excluded from or ineligible to participate in Medicare
• Non-Medicare providers billing patients more than 15% above the Medicare fee schedule when patients are seeking reimbursements from Medicare
• Providing false statements on contracts or applications for Medicare participation
• Violating Medicare physician agreement or assignment provisions
• Providing misleading or false information intended to influence the decision to discharge a patient

Healthcare professionals can be convicted of Medicare fraud if they willfully or knowingly submitted a false claim, engaged in kickbacks or healthcare fraud. While it must be proven beyond a reasonable doubt that their actions were done willfully or knowingly, proof of specific intent or actual knowledge is not required. That means individuals can be convicted if they are found to have acted with reckless disregard or deliberate ignorance of the falsity of the claim.

In some cases, the ultimate issue has come down to whether or not the healthcare professional acted willfully or knowingly. In other Medicare fraud cases, the issues are significantly more complex. The Medicare fraud attorneys at Norman Spencer Law Group have worked for more than a decade in the healthcare field, successfully representing licensed healthcare professionals at all stages of their case.

In addition to providing a strong fraud defense, our lawyers are skilled in defending clients against charges related to fraud. These can include:

• Conspiracy to commit Medicare fraud: Conspiring to commit fraud
• Money laundering: Using illegally gained proceeds to conceal that activity, or engage in transactions of more than $10,000 derived from false claims
• Wire fraud: Use of telephone or electronic communication in interstate activity conducted in furtherance of Medicare fraud

Medicare fraud convictions carry a wide range of possible sanctions. These include restitution, civil monetary penalties, jail time and other penalties and collateral consequences. Sanctions are dictated by the specific statute that’s been violated.

• False Claims Act: Up to $21,500 per claim, plus three times the amount of government damages and legal fees.
• Anti-kickback statute: Up to $50,000 per violation, plus three times the kickback amount
• Healthcare fraud: Up to $250,000
• Exclusion statute: Up to $10,000 per excluded item claimed, plus three times the amount claimed

• False Claims Act: Up to five years per count, with possibility of a life sentence for multiple counts
• Healthcare fraud: Up to 10 years, with possibility of up to 20 for bodily injury
• Conspiracy to commit healthcare fraud: Up to 20 years
• Money laundering: Up to 10 years
• Conspiracy to commit money laundering: Up to 20 years
• Wire fraud: Up to 20 years

• Loss of DEA registration or professional license
• Expulsion from Medicare and Medicaid programs
• Inability to collect payment on outstanding invoices
• Loss of staff privileges, employment

The sheer number of potential violations and severity of penalties makes it clear that Medicare fraud is a serious violation. Early intervention of an experienced healthcare attorney can make all the difference in a successful defense. Contact the attorneys at Norman Spencer Law Group to schedule a consultation today.