We defend health care providers, suppliers, vendors, and other individuals facing civil and criminal Medicare fraud charges. Our team of Medicare fraud attorneys includes a former Deputy Attorney General for Idaho’s Medicaid Fraud Control Unit and Special Assistant United States Attorney who has significant experience in health care fraud. Our team also includes attorneys with master of laws degrees in health care law who are exceptionally knowledgeable in Medicare fraud laws, CMS regulations and reimbursement issues. Our licensing attorneys are experienced in helping providers protect their professional licenses following Medicare fraud allegations. Together, our team of Medicare fraud attorneys represent individuals with all issues related to Medicare fraud. Our comprehensive approach allows individuals charged with Medicare fraud to hire just one law firm to handle their civil and criminal Medicare fraud issues and subsequent licensure issues. This allows for cost-savings and helps promote a more knowledgeable and skilled defense to Medicare fraud allegations. This approach allows for a strong defense by pooling together the knowledge and experience that our attorneys have obtained in specific areas of law, and allowing us to better protect the provider’s ability to practice in the future by ensuring that the criminal Medicare fraud case is handled in a manner that will aid in helping the provider resolve any subsequent licensing action or civil fraud action.
Medicare fraud encompasses the false claims act, anti-kickback, Stark and health care fraud statutes. Medicare fraud is when an individual knowingly submits a false statement, or makes misrepresentations of fact, to obtain payment from a Federal health care program (Medicare, Medicaid or TRICARE) for which no entitlement would otherwise exist. Individuals who knowingly solicit, pay, and/or accept remuneration to induce or reward patient referrals for services or supplies reimbursed by a Federal health care program, may also be guilty of Medicare fraud. Additionally, making prohibited referrals for certain designated health services can also result in Medicare fraud.
Criminal Medicare fraud convictions require proof beyond a reasonable doubt that an individual knowingly and/or willfully submitted a false claim, or engaged in kickbacks or health care fraud. However, proof of actual knowledge or specific intent is not required to convict a person for Medicare fraud. A person can be convicted if they are found to have acted with deliberate ignorance or reckless disregard of the truth or falsity of the claim. In some Medicare fraud cases, the ultimate issue is simply whether the individual acted knowingly and/or willfully. In other cases, the issues are much more complex. For example, Medicare fraud allegations involving of worthless services, medical necessity or overutilization present an additional question regarding the standard of care. The current government trend is to criminally charge physicians who allegedly prescribe/perform health care services that are not medically necessary. Our Medicare fraud attorneys are uniquely suited to defend these claims. Our knowledge of conditions of payment, conditions of participation, and over 31 years defending physicians accused of malpractice, gives us the knowledge to understand and apply the standard of care, DRG’s, CPT’s, clinical practice guidelines, conditions of payment, etc. in the defense of our clients.
In addition to Medicare fraud defense, our Medicare fraud attorneys are experienced in defending charges related to Medicare fraud.
Early intervention of a skilled Medicare fraud attorney knowledgeable not only in criminal defense but health law is key. Medicare fraud prosecutions are highly specific prosecutions lead by the U.S. Attorney’s Health Care Fraud Division. Thus, defense of Medicare fraud allegations requires a highly specialized Medicare fraud defense team capable of analyzing a voluminous amount of health data with knowledge of billing practices, compliance issues, and medical necessity.
Our Medicare fraud attorneys defend individuals accused of Medicare fraud in Michigan, Florida, Idaho, Ohio and throughout the United States. We are located near the two major “Medicare fraud hotspots”, Miami and Detroit. If you have been arrested, charged or aware of an investigation into your practice regarding Medicare fraud, we encourage you to contact our Medicare fraud attorneys immediately for a free consultation.
Several home health agencies: alleged to have committed Medicare Fraud for improper referrals, performing services outside the plan of care, not having proper authorizations, not having proper re-certifications, etc.
Behavioral services agencies: alleged to have commit Medicare fraud for failure to use the proper CPT code resulting in allegations of fraudulent billing.
Compound pharmacies: We currently defend several individuals in multiple areas regarding compounding pharmacies. Generally, the allegation is that the pharmacy is “mining” patients through the use of a call center boiler room and the patients have no legitimate medical need for the compound, or the allegation is the compound serves no legitimate medical purpose and is no better than an over the counter medication or less expensive script.
Several physicians: charged with receiving remuneration of referring patients and for approving plans of care that were not medically necessary.
Medical directors: alleged to have committed Medicare fraud for receiving a salary or other payment, as well as referring patients to the program they currently work as the medical director.