Sep 18, 2021 · That’s why you need a defense attorney who understands this area of law. If you’re under investigation or facing criminal charges related to Medicaid fraud, it’s critical to retain an experienced criminal defense attorney. In North Carolina, you can count on our legal team at Roberts Law Group to fight for you each step of the way.
Mar 02, 2022 · When you hire the medicare fraud defense attorneys and former government officials of Oberheiden, P.C., you will notice that we concentrate our defense against False Claims Act, CMS Exclusion, Stark Law, Anti-Kickback violations, and fraud charges by focusing on three core abilities. Industry Knowledge. We have industry knowledge.
Sep 03, 2017 · As healthcare fraud involves a culpable mental state, statutory muck is often the legitimate basis of a defense. Just as law enforcement finds criminal intent in the muck, a good defense shows how even the completely innocent doctor would step over the vaguely drawn lines. The Scotus Blog has an excellent article on the void for vagueness issue.
If you have been accused of committing health insurance fraud and are in danger of losing your professional license, the Texas professional license defense attorneys at the Leichter Law Firm can help you build a strong case and defend your practice and your reputation. Contact our offices today at 512-495-9995 .
There are several affirmative defenses that can effectively be used to fight a fraud claim.Innocent Misrepresentation Defense to Fraud.Waiver Defense to Fraud.Statute of Limitations Defense to Fraud.Mar 9, 2021
There are several things you can do to help prevent Medicare fraud.Protect your Medicare number. Treat your Medicare card and number the same way you would a credit card number. ... Protect your medical information. ... Learn more about Medicare's coverage rules. ... Do not accept services you do not need. ... Be skeptical.
Despite the potential for high pay and job autonomy, defense lawyers face a number of challenges in their roles, including negative public perception, demanding clients, overwhelming evidence, time demands and stress.
The Defense Attorney These fall into three broad categories: assigned counsel, contract systems, and public defenders.
Additional examples of Medicare scams include: A person without Medicare coverage offering money or goods to a Medicare beneficiary in exchange for their Medicare number in order to use their Medicare benefits. A sales person offering a prescription drug plan that is not on Medicare's list of approved Part D plans.Dec 7, 2021
Billing ScamsBills from hospitals you did not visit.Bills from providers you do not know.Bills for services you did not receive.Jan 31, 2021
Defense attorney's often get a harsh reputation due to media scrutiny: defending the accused is not always an easy job and having a client's freedom or future resting on your abilities can be quite stressful.
Zealous defense, also known as zealous advocacy, is an ethical principle for practitioners of law. The essential idea is that once a client contracts the services of an attorney, the attorney must then do everything necessary to win the case, so long as it does not violate other ethical principles for the profession.Aug 10, 2018
The defense lawyer's duty to represent the defendant's interests is balanced by his duty to act in an ethical and professional manner. The defense lawyer must not intentionally misrepresent matters of facts or law to the court.Sep 26, 2012
In criminal cases, there are usually four primary defenses used: innocence, self-defense, insanity, and constitutional violations. Each of these has their uses, and not all cases can use these defense strategies.Oct 11, 2019
When it comes to criminal cases, there are usually four major criminal defense strategies that criminal attorneys employ: innocence, constitutional violations, self-defense, and insanity.
We have provided a helpful list of the major criminal defenses below.Innocence. One of the simplest defenses to criminal liability is the defense of innocence. ... Constitutional Violations. ... Alibi. ... Insanity. ... Self-Defense. ... Defense-of-Others. ... Defense-of-Property. ... Involuntary Intoxication.More items...•Feb 12, 2019
Typically, investigations begin by way of Medicaid audits. These are conducted by state agencies (Medicaid is administered by the states, with federal funding and oversight), for purposes of determining compliance, potential overpayments, and to look for possible evidence of fraud that a physician may have committed.
MFCUs have authority under their respective state and federal laws to investigate and prosecute violations of all applicable state laws pertaining to the provision of medical assistance and the activities of providers under state Medicaid plans. Although each state statute is slightly different, MFCU investigations always involve:
Although circumstances for each instance of Medicaid fraud suspicion can differ, an investigation can take several weeks or months.
Whether an instance of Medicaid fraud is considered a felony depends on the state law. Medicaid provider fraud prosecuted at the state level can be a felony or misdemeanor, as contingent by what the state statute governs. In some states, Medicaid fraud is a felony regardless of the amount involved.
Healthcare entities and providers, according to CMS, are defined as individuals or entities that receive Medicaid funds in exchange for providing a service. Among them:
As with Medicare fraud, the federal healthcare system has three primary laws in place for Medicaid fraud matters, and each has its own criminal and/or civil penalties: the False Claims Act, the Anti-Kickback statute, and Stark Law (physician self-referral). In addition, many U.S. states have their own parallel Medicaid fraud-related statutes.
Yes, but only to an extent. A recent U.S. Supreme Court ruling over federal False Claims procedure ( 31 U.S.C. § 3731) clarifies that for most whistleblower/ Qui Tam actions,
Healthcare fraud applies not only to healthcare providers, but instead to “anyone,” including physicians, nurses, practice managers, non-licensed individuals, practice owners, healthcare businesses, and even institutions.
Whoever knowingly or willfully executes or attempts to execute a scheme to defraud any healthcare benefit program or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any healthcare benefit program in connection with the delivery of or payment for healthcare benefits, items, or services, shall be fined or imprisoned of up to 10 years, or both. See 18 U.S.C. Sect. 1347.
The difference between liability and human error is often a fine line that requires convincing negotiation skills and attention to details. The medicare fraud defense lawyers and former government officials of Oberheiden, P.C. have proven healthcare and law enforcement experience.
Healthcare fraud statutes provide for both, making the issue of civil versus criminal a critical threshold question. About 1,400 individuals are indicted in federal court for healthcare fraud each year and more than 2,500 individuals are under Medicare criminal investigation.
Knowingly submitting false statements or making misrepresentations of fact to obtain a federal health care payment to which the healthcare provider is not entitled, e.g. a laboratory submits claims to Medicare for a higher level of services than actually provided. See, 31 U.S.C. Sect. 3729-3733. For the criminal component of the False Claims Act, see 18 U.S.C. Sect. 287.
If found guilty, targets of investigations may be exposed to recoupment requests, non-payment of future claims, civil fines of up to $ 11,000 per false claim, exclusion from federal healthcare programs, treble damages, attorney fees, criminal fines, criminal indictment, or incarceration in a federal prison.
Result: No civil or criminal liability, case dismissed. Defense of a physician owned entity against an investigation by the Department of Justice for alleged fraud.
There are standard terms and phrases that apply to most medical fraud cases. CPT codes ICD-9, ICD-10, , Health Insurance Claim Form (HCFA, 1500), upcoding, unbundling are some that you should know.
Just when you think you are prepared for trial, the U.S. attorney will add, modify and complicate the case by filing a new and more onerous “superseding indictment”. This is routine and you should expect that it will happen. This is especially true and co-defendants drop like flies and cooperate.
Medical fraud is unlike even a special circumstance murder case. The charges are very VERY broad and it is often difficult to relate the listed charges to specific files, billings or conduct. A typical case might charge the following:
Medical fraud is often a battle of experts. Billing and medical practice involves a tension between patient care, profitability and masses of government and insurance company regulations. Reasonable people and hired guns can and will differ on interpretation.
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.
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.
Medicare, FMHP, and Insurance Audits. Because of increased allegations of fraud in the medical field, healthcare professionals are under more scrutiny than ever, and regulators are extremely quick to issue notices of “overpayment” and investigate billing practices and services rendered.
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.
Doctors, administrators, and hospital employees can face Medicaid fraud charges for attempting to wrongfully pursue reimbursement. Provider fraud can come in many different forms. Often, it is as simple as a doctor billing for medically unnecessary services. This results in monetary reimbursement through Medicaid directly to the provider.
Some fraud claims do not involve the providers at all. Instead of attempting to obtain financial reimbursement from Medicaid, these individuals often seek medical care they would otherwise not be entitled to have.
The fallout from a Medicaid fraud allegation could be significant. In addition to criminal charges, you could face damage to your reputation, costly civil claims, or the loss of your professional license.
When an individual is accused of healthcare fraud, the government has to prove that the defendant engaged in a scheme to steal from a healthcare program, such as Medicare, DOL, Medicaid, Tricare, another government insurance program or a private insurance program.
Healthcare law and fraud and abuse investigations operate in a small circle of lawyers and government officials. Attorneys frequently run into the same FBI agents and work routinely with the same prosecutors and appear before the same judges. This experience may help the lawyer to better anticipate the government’s next step, and may ease settlement negotiations with the government. After all, if your lawyer kept his or her word in the last case, the prosecutor will remember and trust him or her in this case. People talk, and lawyers at the U.S. Attorney’s Office and healthcare fraud defense attorneys are no exception. Reputation and past interactions with the government can make a decisive difference, especially in areas like healthcare investigations where the line between mistake and criminal misconduct can be very thin at times.
That is, someone, often a former employee or a competitor, reports alleged fraud to the government by filing a lawsuit in an effort to later collect a reward. Targets of these whistleblower cases often find out about the existence of an investigation when they receive a Civil Investigative Demand (CID) or another form of a government subpoena (e.g. OIG subpoena) requesting documents and corporate information. The absolute priority in all of these defense cases is to make sure that the investigation does not turn into a criminal case—that is something Oberheiden P.C. has accomplished in every single whistleblower case. By the same token, Oberheiden P.C. is an asset protection specialist and protected the financial stability of its clients by dismissing or favorably settling these types of cases (e.g. in Los Angeles, in Florida, in Houston, in Philadelphia, in Dallas, in Portland, in Ohio etc.).
The federal Anti-Kickback Statute is a criminal statute that prohibits persons or entities from knowingly and willfully soliciting, receiving, offering, or paying remuneration for referrals for goods or services payable to a government healthcare program , such as Medicare, Medicaid, and Tricare.
As seen, healthcare fraud is a generic term that encompasses a variety of conduct designed to illegally obtain a financial benefit of a provider to the detriment of the state or federal government. The following list is not exclusive, but it summarizes some of the most common fraud examples.
Federal Imprisonment – In criminal healthcare fraud cases, practitioners and business owners can face the potential for years , or even decades , of federal imprisonment. Civil or Criminal Fines – Civil and criminal healthcare fraud offenses also carry steep fines, with fines often applying on a “per-claim” basis.
Regardless of your role within the healthcare industry, facing federal fraud allegations is an extremely serious matter. If federal agents are targeting your business or practice based upon allegations of Medicare, Medicaid, Tricare, or Department of Labor (DOL) fraud, failing to find the best healthcare defense could result in exposure to significant civil or criminal penalties.