Contact Us for a Free Consultation (213) 542-0979

Medicaid Fraud

Federal Medicaid and Medicare Fraud Defense Attorney

Medicaid fraud occurs when health care providers, including doctors, hospitals, and dentists, bill the government for payment of medical goods and services that were never delivered or provided. Basically, Medicaid fraud is the theft of government money through the making of false statements.

Medicare fraud is a felony that the federal government takes very seriously. At Hedding Law Firm, our federal criminal defense attorneys will look at all the facets of the case in defending you. The prosecution must prove that there was an actual intent to deceive. This must be proven beyond a reasonable doubt.

Medicare fraud occurs when people or companies purposely bill Medicare for never provided or received services. For example, your Medicare number could be used to bill Medicare for services and supplies you did not need, want, order, or receive. Medicare fraud typically occurs in nursing homes, hospitals, residential facilities, hospices, and other health care providers.

Medicare Fraud lawyer

Physicians or healthcare entities that are found to have committed Medicare fraud face serious consequences. They will be required to repay the Medicare overpayment they received, and they will likely face significant financial fines. Further, they may face criminal prosecution by the federal government.

The False Statements Act, 18 U.S.C. §1001:

Healthcare providers found guilty of this federal crime by intentionally providing false statements to the government in the form of documents or written communication that try to conceal facts are guilty under this act.

Medicaid Fraud

Penalty for conviction under this Act is a fine not exceeding $10,000 or imprisonment of up to five years.

Medicaid fraud has different forms – as far as – a different schemes in which it is committed. Some common schemes are filing false time sheets, billing for face-to-face visits when in reality, there was no meeting, submits billings for physician office visits when the clinic has no licensed physician on staff.

Medicaid Fraud Penalties

  • Imprisonment for up to 5 years
  • Fines up to $20,000
  • Civil penalties of $2,000 per false claim
  • Exclusion from Medicaid

Different Types of Medicaid Fraud

There are a number of different types and forms of Medicaid fraud that can be prosecuted by the government.  Sometimes people submit bills for false services.  Other times, individuals use other people's medical cards to get services performed against them.

When it comes to this type of fraud where the government is actually losing money, they will arrest people, charge them with crimes, and/or force them to pay the money back in the form of what they call restitution.  They can punish them with jail time or probation.  They can lose certain rights for a significant period of time.  There's all types of punishment that can be related to a Medicaid fraud case.

So, if you're charged with Medicaid fraud, you should get an attorney who has experience with this because sometimes the government doesn't get it exactly right.  They don't realize certain things related to you.

Remember, it's a big bureaucracy that's set up, and once they see that you do something wrong and there's a perception there as far as their system goes that you violated some rule then they're going to come at you, but that doesn't mean that they always get it right.

Different Types of Medicare Fraud

The government has ramped up a task force to go after individuals involved in any type of Medicare fraud.  This can take many different frauds — doctors can be involved or patients can be involved.

It basically has to do with getting money from the government for the health of insurance in the form of Medicare and using that money in an improper way or gaining it in an improper way, or filing for false services.

There are all sorts of different scams that are out there and the government is paying out hundreds of thousands, millions of dollars related to Medicare fraud claims and if they determine that people are using that money inappropriately or improperly, they will file criminal charges.

First, it will start in their investigative body, which is more of a bureaucracy in a civil branch and then if it is determined that there is some sort of criminal activity involving Medicare fraud, the next thing that will happen is it will be moved to the criminal task force.

Once it's moved to the criminal task force, then they're in a position where the person will be approached and talked to.  Basically, what is going to happen is they're going to try to question that person about what they believe they're doing Medicare fraud-based and if that person says anything to incriminate themselves, obviously they will use that information and prosecute them.

Other times, they simply go and arrest the person because they have the evidence on the person that they're involved in some sort of Medicare fraud scheme.  Again, this is the government protecting its money.  They're giving thousands of dollars out every single day, so people have taken advantage of this, and in taking advantage of it, thousands of dollars are being wasted.

The federal government obviously needs to police this.  Sometimes this involves doctors.  Sometimes it involves patients, and sometimes it involves all of those entities or individuals involved in stealing money from the government.

Lawyer to Develop a Defense Strategy

That's why sitting down with an attorney and going over the facts and details can help the attorney understand exactly what happened so they can properly defend you.  But realize when you are getting Medicaid services, you will typically have to sign documents and agree to certain rules.

A lot of times, people don't pay attention to that, and the next thing you know, they're violating those rules without even realizing it.  That's typically not going to be a defense in a Medicaid fraud case.  You're expected to know and realize that you have certain things that you're supposed to do if you want to collect those benefits and certain things that you can't do if you want to collect those benefits.

So, the best move if you're charged with a Medicaid fraud-related crime is to get a strategy together and decide first, is this a case I'm going to fight all the way to a jury trial?  Then you sit down with your attorney and determine your defense.  Obviously, you want to make sure that your defense makes sense under the circumstances of your case and the current state of the law.

What I do often in these Medicaid fraud cases is get the jury instructions that apply to the charges you have pending against you.  We see exactly what elements the government is going to have to prove to find you guilty, and then we can have a frank discussion about whether they're going to be able to do that.

We also look at potential defenses and see if you can meet any of those defenses with evidence.  You could testify and there's other evidence that could be brought to bear depending on the facts and circumstances surrounding your case.

So, if you're charged with a Medicaid fraud crime in Los Angeles, pick up the phone, make the call, and let's sit down and talk.  Let's decide what we can do to get you out of the criminal justice system as fast as possible. Contact a Medicaid fraud lawyer at our office today, and we get your federal criminal charges under control and place every effort to get you the best results possible.

Also See:
Will I Go to Jail If Charged with Medicare Fraud?