Jun 24, 2019 · If your case is average a rule of thumb is one month’s nursing home bill for devising your best asset and income protection strategy, completing the application and handling it in the Medicaid agency. If the work is much more complicated it may cost twice that. We’ve heard reports of some attorneys charging $25,000 and more.
Contact Us Regarding Any Case on Medicaid Fraud. Our Medicaid fraud defense attorneys at The Healthcare Fraud Group will advocate aggressively in court on your behalf. Contact us now for a free consultation or call 888-402-4054 on your Medicaid fraud case.
The federal agency tasked with administering Medicare and Medicaid – the Centers for Medicare and Medicaid Services – has reported that about $60 billion of American taxpayer money was paid for fraudulent claims in a recent year, according to ABC News. This amount represents an astounding 10% of the total budget for Medicare and Medicaid for that year.
Nov 25, 2016 · Many lawyers claim to handle Medicaid fraud cases but are really general practitioners. They may be criminal defense lawyers who spend 10% or 20% of their time on Medicaid fraud and the rest of ...
Medicaid fraud involves falsifying information to benefit from reimbursements beyond the actual cost of what services were provided. Several penal codes have been put in place to protect American citizens and punish those who try and defraud Medicaid. Unfortunately, some people get accused of crimes they didn’t commit.
Medicaid Fraud Investigation Process. As the government investigates during the interview, the case on false claims is examined. The prosecutor handling the case engages the government agency responsible for getting its opinion on the matter.
One of the only ways to properly defend yourself is by working with an Attorney General’s Medicaid Fraud Unit.
Also known as fraudulent billing, phantom billing occurs when no services were rendered, but a billing form is submitted. In this form of fraud, services get billed even though they never happened. Fraudulent or phantom billing can be a significant problem for medical professionals.
Kickbacks are not allowed in the medical profession. When they happen, Medicaid fraud is committed. Kickbacks are secret payments between people working in the medical industry and healthcare providers. A kickback occurs when a hidden payment is offered to a healthcare provider in exchange for using a particular service or medical item. Such cases are common, and medical professionals are frequently accused of such crimes.
One of the most popular forms of Medicaid fraud is Upcoding. It occurs when procedures get billed more than they should cost. Because the Medicaid billing process is extremely complex, it is oftentimes hard to detect errors. As a result, an individual in the medical field who committed no crime might get charged with a billing error that could send them to prison. When a doctor or any medical professional gets accused of Medicaid upcoding fraud charges, they should contact a Medicaid fraud lawyer general immediately.
For any procedure or service to get paid, it should meet Medicaid billing standards. If a process or service is performed that is justified as being unnecessary, then a medical professional may face unnecessary services Medicaid fraud charges. If these charges are brought against any medical professional, the services of an experienced Medicaid attorney should be sought out immediately.
Medicare and Medicaid fraud consists of schemes running from those that are relatively simple (such as “upcoding” billing for procedures) to those that are complex ( and which may involve fake patients and a wide variety of participants).
The False Claims Act was enacted during the Lincoln presidency, which is why it is sometimes known as the “Lincoln Law.” Under the False Claims Act, whistleblowers are entitled to file lawsuits against individuals, companies, and entities perpetrating fraud against the federal government. To encourage such cases, the False Claims Act provides for compensation to be paid to such whistleblowers in the event of a successful outcome based upon a percentage of compensation that is ultimately recovered.
Medicare and Medicaid Fraud are not victimless crimes. Each year, billions of dollars in taxpayer money is fraudulently paid to physicians, hospitals, clinics, and medical offices for medical services, prescriptions, and equipment as part of the federal government’s Medicare and Medicaid programs. This is your money and my money. Fortunately, under the False Claims Act, whistleblowers are encouraged to expose fraud through potential compensation opportunities, which ultimately serves to reduce fraud.
Possible Medicaid Fraud Outcomes 1 Criminal charges 2 Licensing Action 3 Expulsion from the Medicare or Medicaid program 4 Loss of staff privileges 5 Inability to collect outstanding invoices 6 Fines
Health Insurance and Medicaid Fraud Attorney. According to the U.S. Government Accountability Office, about $1 out of every $7 to Medicare is lost due to insurance fraud and abuse. As a whole, insurance fraud may involve up to $100 billion in stolen funds each year.
Medicaid audits are conducted by state agencies for the purposes of determining compliance, overpayments, and to look for evidence of Medicaid fraud on behalf of a physician. Often, Medicaid audits are conducted in response to a complaint from a patient, whistleblower or Medicaid plan.
The most commonly-reported type of health insurance fraud is a false claims scheme. Any of the following actions, if performed fraudulently, could be considered health insurance fraud: Ordering tests or performing services that are unnecessary. Billing for services or procedures that were not rendered. Misrepresenting a condition or a service.
Medicaid fraud prosecuted at the state level can be a felony or misdemeanor. It depends on the state law. In Texas, healthcare fraud can range from misdemeanor to a felony offense. Convictions. Felony Convictions. DUI. Embezzlement. Health Insurance Fraud. Illegal Billing Practices.
The criminal penalties for Medicaid fraud in Florida include: Third-degree felony ($10,000 or less in value): $5,000 fine and five years of imprisonment. Second-degree felony ($10,001 to $49,999 in value): $10,000 fine and 15 years of imprisonment. First-degree felony ($50,000 or greater in value): $10,000 fine and 30 years of imprisonment.
In broad terms, Medicaid fraud involves any method (either intentional or unintentional) of obtaining funds from Medicaid where (i) the funds are not properly owed, or (ii) the funds are used for an improper purpose (such as payment of referral fees). Medicaid fraud can be charged as a civil violation or as a crime, ...
To speak with the Medicaid fraud defense attorneys at Oberheiden, P.C., please call (888) 452-2503 or contact us online. With offices in California, Louisiana, Michigan, New York, and Texas, we represent health care providers nationwide .
Under the federal health care system, the primary fraud laws that apply to Medicaid providers are the False Claims Act, the Anti-Kickback Statute, and the Stark Law. Most states have adopted analogous statutes as well, although specific prohibitions and penalties vary from one state to the next. Some states, such as Florida, have enacted numerous different statutes that apply to health care providers, with some that apply industry-wide and some that apply only to certain medical facilities and licensed practitioners.
In Texas, Medicaid fraud can be charged as a civil violation, a misdemeanor, or a felony offense depending upon the specific circumstances involved. In each type of case, potential penalties include: Civil: Civil monetary penalties. Misdemeanor: Tens or hundreds of thousands of dollars in fines for each violation.
Penal Code Section 550 (a) (Preparing, Making or Submitting a False Claim): Misdemeanor penalties (for claims of $950 or less) of one year in jail and a $1,000 fine, or felony penalties (for claims greater than $950) of two to five years of incarceration plus the greater of $50,000 or double the amount of the fraud.
False Claims Act (31 U.S.C. Sections 3729-3733) The False Claims Act makes it a federal offense to submit any “false or fraudulent” claim to the government. This includes overbilling Medicaid. There are potential civil and criminal penalties under the False Claims Act.