what kind of lawyer to i need for medicaid fraud

Full Answer

Do you need a Medicaid fraud attorney?

Medicaid/Medicare fraud is not an easy legal process to navigate on your own. If someone stole your identity, gained unlawful access to your healthcare number, and hurt you financially through a fraud scheme, an attorney can help you recover damages. Your lawyer will walk you through the steps of claiming reimbursement for healthcare fraud.

How to become a fraud lawyer?

Their job responsibilities may include:

• Reviewing statements and records for evidence of suspected fraud
• Train employees to prevent future cases of fraud
• Recognizing warning signs of potential wrongdoing

Can I be charged with Medicaid fraud?

You can be charged with Medicaid Fraud if the state’s attorneys believe that each of the elements of 35A.02 as described in the section above have been met. What is the punishment for Medicaid Fraud? The penalty range for a Medicaid Fraud conviction ranges from a Class C misdemeanor to a felony of the first degree, ...

What is considered fraud with Medicaid?

• Payments for any medical services, treatment, supplies, or equipment that you did not receive;
• Dates of service or provision of items that differ from the dates on which you actually received the service or items;
• Payments for ambulance transportation that was not provided to you; and

More items...

Which of the following is an example of Medicaid fraud?

Medicaid fraud occurs when a member or provider knowingly cheats or is dishonest, resulting in a benefit such as payment or coverage that would not have been provided. Examples of Medicaid fraud: Knowingly billing for services or supplies not provided. Knowingly billing for more services than were actually provided.

What agency fights Medicare fraud?

the Office of the Inspector GeneralHave your Medicare card or Medicare Number and the claim or MSN ready. Contacting the Office of the Inspector General. Visit tips.oig.hhs.gov or call 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.

Who investigates Medicaid fraud Texas?

The OAG has broad authority to investigate and prosecute cases of Medicaid fraud under the Texas Medicaid Fraud Prevention Act (TMFPA).

Does the FBI investigate Medicaid fraud?

What we typically look at in the FBI is fraud that targets both the public health insurance programs, ones that most people would commonly recognize—Medicare, Medicaid. We also look at fraud that targets private insurance plans.

How do you fight Medicare fraud?

If you suspect Medicare fraud, do any of these: Call the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950. Visit tips.oig.hhs.gov to file a complaint online.

What is Medicaid fraud Texas?

What is the current Texas law about Medicaid Fraud? (12) knowingly makes, uses, or causes the making or use of a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to this state under the Medicaid program.

How do I report disability fraud?

Phone: Contact the National Benefit Fraud Hotline on 0800 854 4400. Your call is free and confidential you do not have to give your name or address.

What is Medicare waste?

Medicare Learning Network® LESSON 1 PAGE 3. Waste and Abuse. Waste includes practices that, directly or indirectly, result in unnecessary costs to the Medicare Program, such as overusing services. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources.

How Can I Find the Right Medicaid Fraud Attorney to Handle My Case?

In searching for a Medicaid fraud attorney specializing in Qui Tam Lawsuits, carefully read the attorney’s bio. You might want to consider what they say are their specialties. You will want to see evidence of their track record with these types of cases, as well as if they ever worked for the government. For example, you don’t want to hire a divorce lawyer to file your Qui Tam! More likely a better choice would be to choose an attorney who previously worked for the Department of Justice and specifically prosecuted Healthcare fraud for that office. Even better would be to find one that recently left the US Attorneys Office and can still pick up the phone to encourage a Qui Tam Lawsuit on your behalf.

What to do if you are arrested for Medicaid fraud?

If you have been arrested or are being investigated for Medicaid fraud, you will want to speak to a criminal defense attorney specializing in this type of defense. On the other hand, if your employer is defrauding Medicaid, Medicare or some other type of federally funded program, you will want to speak to a Whistleblower lawyer who handles Qui Tam lawsuits.

What is a Qui Tam lawyer?

Qui Tam attorneys specialize in Whistleblower lawsuits that are brought on behalf of individuals who wish to report the defrauding of government programs. These individuals, or in some cases small groups, are usually employees of a company that is conducting the fraud, and their job gives them firsthand access to information pertaining to it. In the case of Medicaid fraud, the person may be employed by a hospital, urgent care center, radiology clinic or any other type of facility that accepts Medicaid and Medicare. In cases like these, billing is usually falsified in some manner to reflect services that were not performed in order to facilitate higher reimbursement rates from Medicaid. Often times the bills are inflated to reflect higher rates of care that were not administered to the patient. There are many devious ways in which unscrupulous people can defraud Medicare or Medicaid. If you work in a billing department of one of these facilities and a supervisor instructs you to perform billing in a way that doesn’t coincide with the actual services rendered, you may want to consider making a confidential call to a Medicaid fraud attorney specializing in Qui Tam /Whistleblower Lawsuits.

How to defend yourself against Medicaid fraud?

One of the only ways to properly defend yourself is by working with an Attorney General’s Medicaid Fraud Unit.

Why is it important to handle Medicaid fraud cases?

It is important that Medicaid fraud cases get handled timely and accurately. In the absence of a skilled and knowledgeable Medicaid attorney, healthcare professionals will oftentimes lose a case against them.

What happens if you are convicted of Medicaid fraud?

An unqualified and unexperienced Medicaid fraud defense attorney may lose a case even though their client is innocent. As a result, medical professionals may find themselves facing significant legal consequences. The federal government is stringent on Medicaid charges and charges may end a medical professional’s career. When an individual’s medical practice is accused of Medicaid fraud, their practice is subjected to serious investigations and scrutiny. If the healthcare professional is convicted, they will spend a minimum of five years in a government correctional facility. Also, the fines and fees one is forced to pay as a result of a Medicaid fraud conviction are significant. Some are forced to pay over a million dollars if convicted.

What to do when you discover you are under investigation for Medicaid fraud?

When you discover that you’re under investigation for Medicaid fraud, do not panic. Consult a professional Medicaid fraud defense attorney immediately.

What happens after the government investigates a Medicaid fraud case?

After the government investigates the case on Medicaid False Claims Act, it decides on whether or not to pursue or drop the case. In case the government continues with the case, it serves the defendant with a complaint.

What is Medicaid fraud investigation?

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.

What is Medicaid fraud?

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.

Common Types of Medicaid Fraud

Medicaid fraud can be described as the act of deliberately misrepresenting the truth to get unauthorized benefit. Such frauds can be grouped under three categories:

What is Medicaid Abuse?

Whistleblower law also applies to the exposure of Medicaid abuse. Abuse encompasses practices that are not in line with acceptable medical, business or financial practices, and that result in an unnecessary increase in costs. Abuse can also mean physical ill-treatment of the Medicaid beneficiary.

Who Investigates Medicaid Fraud and Abuse?

The government has set up Medicaid Fraud Control Units to investigate all claims of fraud with the Medicaid healthcare system. These MFCUs are operational in 49 States, as well as the District of Columbia. A majority of these units are part of the State Attorney General office, the rest being in various other State agencies.

How Whistleblower Law Tackles Medicaid Fraud and Abuse

In many cases, it is the employees of the institution or individual providing Medicaid services who come to know of the fraud. Fear of retaliation by the employer may force these individuals to remain silent about the fraud or abuse.

What Does a Medicaid Fraud Lawyer Do That a Regular Fraud or Criminal Attorney Doesn’t?

At Chapman Law Group, our national Medicaid fraud defense attorneys are keenly aware of the negative impact a criminal indictment will have on your career. Your license is affected, along with your standing with your employer, your reputation with your peers, and your continued inclusion in the Medicaid and Medicare programs.

What Entities Can Be Found Legally Guilty of Medicaid Fraud?

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:

How Does the Medicaid Fraud Investigation Process Unfold?

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. Often audits are conducted in response to a complaint received by the state from a patient, a whistleblower ( Qui Tam ), or a Medicaid plan.

What Do Medicaid Fraud Investigators from the MFCU Do?

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:

How Long Does a Medicaid Fraud Investigation Take?

Although circumstances for each instance of Medicaid fraud suspicion can differ, an investigation can take several weeks or months.

What Penalty, Jail Time, or Other Punishment is There for Medicaid Fraud?

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 penal ties: 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.

What happens if a state auditor suspects fraud?

If state auditors suspect fraud, they will refer the matter to the Medicaid Fraud Control Unit (MFCU). Audits can result in tens of thousands of dollars in overpayment demands, false claims charges and anti-kickback actions.

How can a fraud attorney help you with Medicaid?

An experienced Medicaid fraud attorney can help you by negotiating a settlement that reduces the amount owed, by avoiding penalties and interest - and, most importantly, by negotiating an agreement that your case will not be referred for criminal prosecution.

What is Medicaid fraud investigator?

The Medicaid fraud investigator has information that suggests you are not qualified for benefits. This information may include payroll records, car registrations, property records, and business records. The investigator may have spoken with your employer, your co-workers, or your neighbors.

What are the penalties for Medicaid fraud?

Some of the possible consequences are: monetary fines, penalties, and restitution orders. disqualification or exclusion from receiving Medicaid benefits. civil judgments and liens on any real property you own.

What happens when you are investigated for Medicaid fraud?

When a recipient of Medicaid or Family Health Plus benefits is investigated, the investigator may suspect that the recipient did not tell the truth or failed to disclose all of their income and assets when they applied for benefits. Some common types of Medicaid fraud involving recipients include:

How to respond to an investigation?

How you respond to the investigation depends on your particular facts and circumstances. Some questions and requests for documents are appropriate. Others may be improper. Sometimes it makes sense to cooperate with the investigator and negotiate a resolution. Other times you must fight to protect your rights.

Do you have to answer an investigator's questions?

You also have the right to consult with your lawyer before providing any documents or answering any questions. You have the right to remain silent. You do not have to answer the investigator's questions.

Can you remain silent on a medicaid claim?

You have the right to remain silent. You do not have to answer the investigator's questions. If you are a Family Health Plus or Medicaid recipient, your benefits cannot be stopped solely because you refused to answer questions.

What happens if you are accused of fraud?

Otherwise, you put your rights at incredible risk and can end up facing a huge array of penalties and legal repercussions.

Who should be forthcoming about Medicaid?

The hospitals, clinics and physicians who work with you should be forthcoming about your Medicaid or Medicare benefits. If they are not, you may want to seek legal advice.

What to do if you are denied Medicare?

If you have been denied such coverage, the best thing to do is to consult with a lawyer who specializes in Medicare and Medicaid law. Simply accepting a denial on a claim may not be a smart course of action. Many times, you do have legal recourse.

Is Medicare and Medicaid confusing?

Medicare And Medicaid. The Medicare and Medicaid system in the United States can be tremendously confusing. When you are denied Medicaid benefits or otherwise have problems with a social welfare program, it can feel like you are all alone.

Who is responsible for investigating Medicaid fraud?

The agency responsible for investigating Medicaid recipient use and other claims of fakery is the U.S. Health Department’s Office of Medicaid Management.

What are some examples of fraud on Medicaid?

Examples of Medicaid user fraud include: The loaning of Medicaid ID cards to others. Changing or faking an order or prescription. Utilizing more than one Medicaid identification card.

What happens if you find a fraud in Medicaid?

There are types of fraud, like prescription drug forgery, that if found during their investigations, the Office of Medicaid Management will turn over to other agencies for follow up and prosecution.

What is the number to call if you believe a Medicaid user has participated in any of the actions listed above?

If you believe a Medicaid user has participated in any of the actions listed above or any other dubious activity, please call 1-877-87FRAUD. You can choose to make your statement anonymously.

What is the number to call for Medicaid fraud?

If you suspect that a recipient has engaged in any of the activities listed above or any other questionable activity, please call 1-877-87FRAUD.

What is considered fraud?

Any services billed that weren’t actually provided are considered fraud and need to be reported.

How to file a complaint with a nursing home?

If you feel the need to file a complaint, ask a sympothetic staff member how you should go about it. You also may want to ask the nurse in charge to review your family member’s care plan. If you still are uncomfortable with the situation, speak to the director of nursing, the social worker, or the administrator or check to see if the nursing home has a family council, a group of advocates who try to improve the quality of life in the home.Often, nursing homes operated by large corporations have toll-free telephone numbers you can use to speak to a regional supervisor.

What is the role of a Medicaid attorney?

On the other hand, Medicaid attorneys often focus more on the legal aspects of Medicaid planning, such as creating Medicaid asset protection trusts or Qualified income trusts, which makes them the better option for this type of assistance.

How much does it cost to hire an elder care attorney for Medicaid?

After the consultation / planning conference and gathering of the facts and needs, a price for services can be quoted. Medicaid planning fees can range from $3,000 to $12,000.The following factors can all impact the cost the cost of a Medicaid planning engagement. The more complicated the case, the higher the fees.

How long does it take for Medicaid to pay for long term care?

Medicaid attorneys and specialists also assist with crisis planning, which occurs when a senior needs Medicaid benefits within 30-60 days.

How to avoid looking back on medicaid?

One such strategy that elder law attorneys can implement is a Medicaid asset protection trust (MAPT). This type of trust not only prevents one from becoming ineligible for Medicaid due to gifting assets (if done prior to the look back period), but it also allows one to protect assets for spouses to ensure they can live independently. Furthermore, MAPTs protect assets, including one’s home, for relatives upon the death of the Medicaid recipient, as assets in this type of trust are protected from Medicaid’s estate recovery program. This means that the state cannot attempt to be reimbursed for long term care costs for which it paid for the Medicaid beneficiary via these assets.

What is a medicaid planner?

For persons who have Medicaid cases that are fairly simple and straightforward, a Medicaid planner, also called a Medicaid specialist or a Medicaid Advisor, might be a good option. Working with a professional Medicaid planner can be a lot more cost efficient than working with a Medicaid attorney.

What do elder law attorneys do?

What Elder Law Attorneys Do? Elder law attorneys, also called elder care attorneys, estate and trust attorneys, or Medicaid lawyers, assist persons in preparing for long-term care and death. They assist seniors in a large and diverse array of legal tasks, which encompasses retirement planning, estate planning, creating wills and durable power ...

Can a Medicaid attorney help with paperwork?

Medicaid lawyers, first and foremost, are able to assist Medicaid applicants with the application process, such as filling out the paperwork, providing supporting documentation, and filing the application. While this process can be labor intensive and complicated, in most states it is not required that the person providing assistance be an attorney. For this task, a professional Medicaid planner might be better suited, as it is generally more affordable than hiring an attorney. Learn about the various types of Medicaid planners here.