Our team of attorneys is dedicated to defending providers and suppliers suspected of Medicare fraud. Our team includes a former Deputy Attorney General for the Medicaid Fraud Control Unit (MFCU) who prosecuted health care fraud cases. They have significant experience in health care fraud investigations, audits, and civil and criminal Medicare fraud actions. We have built our team of Medicare fraud defense lawyers to represent individuals accused of fraud nationwide, through offices in Detroit Michigan, Miami, Tampa, and Orlando Florida, Columbus, and Houston Ohio, and Boise Idaho areas. Our clients include physicians, chiropractors, pharmacists, home health agencies, urgent care centers, and behavioral health facilities.
Medicare fraud encompasses the false claims act, anti-kickback, Stark and health care fraud statutes, and 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, along with those making prohibited referrals for certain designated health services.
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 for a conviction. 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 defense lawyers 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 defense, our attorneys are experienced in defending charges related fraud.
Early intervention of a skilled lawyer knowledgeable not only in criminal healthcare defense but health care law is key. Medicare fraud prosecutions are highly specific prosecutions lead by the U.S. Attorney’s Health Care Fraud Division. Thus, the defense of such allegations requires a team of highly specialized Medicare fraud defense attorneys capable of analyzing a voluminous amount of health data with knowledge of billing practices, compliance issues, and medical necessity.
Our Medicare fraud lawyers defend individuals accused in Michigan, Florida, Idaho, Ohio and throughout the United States. We are located near the two major “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 offices 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 committed 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.
We have licensed lawyers in Detroit Michigan, Miami, Tampa, and Orlando Florida, Boise Idaho, and Columbus Ohio areas, and work on federal cases nationwide.