Medicaid Fraud Defense Attorneys

The investigation and prosecution of Medicaid fraud have increased in recent years, with local authorities are dedicating significant resources to aid in its elimination. In fact, a number of states encourage staff members and patients to file fraud whistleblower cases by awarding them up to one-third of the recovered money.

While the encouragement may be helpful in some cases, in others it has resulted in investigations of even the smallest discrepancies and billing errors. The attorneys at Norman Spencer Law Group have been representing and defending licensed healthcare professionals in all types of cases, including those involving Medicaid fraud defense.

State agencies conduct Medicaid audits to verify compliance as well as look for potential overpayments and evidence of fraud. Audits may be launched in response to a patient compliant, a whistleblower lawsuit or at the Medicaid plan. Healthcare professionals may be subjected to an onsite audit or a desk audit, which is an offsite audit of records.

A variety of methods are used to detect overpayment and fraud. A common one is data mining, which involves sorting claims through statistical models to identify anomalies. Auditors may also compare one provider’s claims with a similar provider’s claims in the same geographic area.

When fraud is suspected, state auditors refer the case to the Medicaid Fraud Control Unit, or MFCU. Depending on the violations found, audits can result in false claim charges, anti-kickback actions, and tens of thousands of dollars in overpayment reimbursements.

The severity of audit penalties makes it imperative to seek legal assistance from an experienced Medicaid lawyer if you’re subject to an investigation or audit. The attorneys at Norman Spencer Law Group have more than 10 years’ experience in the legal healthcare arena, and we aggressively work to protect your interests.

Our lawyers work with clients to ensure sufficient information is submitted to support their claims and help avoid overpayment demands. In certain circumstances, we have also prevented licensing action, overpayment action or criminal charges from being filed against clients in the first place.

Both civil and criminal charges can result from Medicaid fraud accusations. While most health law matters are notoriously slow moving, Medicaid fraud cases progress rapidly. They can also have devastating effects if not handled properly and in a timely matter. Medicaid fraud cases are also often assigned to prosecutors that specialize in abuse and fraud laws. That makes it vital to retain an extensively experienced Medicaid fraud attorney as soon as possible if you’re ever targeted for an audit or investigation.
The legal team at Norman Spencer Law Group is extremely knowledgeable and experienced in both civil and criminal Medicaid fraud issues. We help licensed healthcare professionals with Medicaid fraud investigations, audits, overpayment matters and all types of civil and criminal actions.

When clients are facing Medicaid fraud charges, we work with them to establish a strong defense and protect their interests. Depending on the specifics of the case, we may strategize to have the case dismissed. If the evidence is against a client, we can also work to attain the most favorable outcome that has the least impact on their career.

Several different types of Medicaid fraud exist, with some of the most common including:

• Submitting false invoices
• Billing for services that were not provided
• Billing for equipment that was not provided
• Billing individually for services that are supposed to be coded and billed as part of a bundle
• Over utilization of specific medical services or procedures

Penalties for Medicaid fraud can be serious. Some of them include:

• Criminal charges
• Fines and fee reimbursement
• Elimination from the Medicaid program and Medicare program
• Action against professional healthcare license
• Inability to collect outstanding balances on invoices
• Loss of staff privileges

Medicaid fraud audits can be serious, too, as each has the potential to evolve into criminal and civil action. These include state licensing and civil recovery issues. Any of these situations have the capacity to cause significant, long-term harm to healthcare providers, with sanctions that include jail time, monumental fines, and suspension or even revocation of your professional license.

The Medicaid defense fraud lawyers at Norman Spencer Law Group work in tandem with your health law and licensing lawyers to prevent or resolve matters stemming from fraud allegations. These may include issues relating to licensing, credentialing and CMS enrollment.

Our experienced healthcare attorneys are well aware of the detrimental impact a criminal indictment can have on the career of a licensed healthcare professional. It can impact your status with your employer, your state license, your reputation with your colleagues and the community at large. It can also have an effect of your standing within the federal Medicaid and Medicare programs. Our attorneys work to not only defend our clients against fraud charges, but to also limit the effects of such charges on their overall career. Schedule a consultation with a lawyer at Norman Spencer Law Group today.