Medicaid Fraud Investigation Process and Penalties
The National Healthcare Criminal Law Attorneys at Chapman Law Group Explain How Medicaid Fraud Investigations are Handled Medicaid provider fraud is a unique focus area
Chapman Law Group’s own Ronald W. Chapman Sr. was recently interviewed by Alicia Jessop, a writer for The Athletic. This interview comes in the wake of a health care fraud scandal surrounding 10 former players including Clinton Portis, the famous Washington running back.
On or about December 12, 2019, the Department of Justice (DOJ) indicted 10 former NFL players in U.S. Federal Court on charges of conspiracy, wire fraud, and health care fraud for false claims amounting to $3.9 million.
The allegations specify that the players submitted claims to a health benefits and allied services provider known as the “Gene Upshaw NFL Player Health Reimbursement Account Plan” (Plan), for phony purchases of medical equipment between June 2017 and December 2018.
The Plan provides for tax-free reimbursement of out-of-pocket medical care expenses that were not covered by insurance and that were incurred by former players and dependents.
The former NFL players being charges are Correll Buckhalter, C.C. Brown, Tamarick Vanover, Clinton Portis, John Eubanks, James Butler, Fred Bennett, Carlos Rogers, Robert McCune and Etric Pruitt.
Under the Federal False Claims Act, persons or entities who defraud or conspire to defraud federal government programs are held liable and subject to severe monetary penalties, including the damages owed to the federal government in restitution, in addition to penal damages, treble damages and penalties linked to inflation.
Consequently, submitting claims for federal reimbursement when the claims concern fake medical expenses is considered a “false claim” covered by the Act.
Ron explained:
“[The defendants] can get as much of a 40% reduction in their sentences if they offer the government solid evidence in support of somebody else’s wrongdoing. That is often what the government looks at — they indict some people with the hopes of getting other people.”
Going into further detail, Ron emphasized the severity of the situation and that indeed in most circumstances the government ensures a hefty punishment even with sentence reduction.
“The settlement usually requires two things. First, the repayment of any amount lost, plus penalties on top of that. Second, some prison time will be required under a settlement. The government is pretty strong on ensuring that someone gets some time in these cases.”
Ron also spoke on the NFL healthcare fraud case with Texas attorney Mike Meltser on Meltser’s eponymous podcast.
If you are a medical professional facing charges for healthcare fraud, we are the law firm for you.
The health care fraud defense lawyers at Chapman Law Group will aggressively defend your health care matter from internal investigation through trial. We handle multistate federal criminal matters investigated by the Department of Justice; state felony matters; and, where criminal sanctions are possible, investigations commenced by the HHS, FBI, DEA, FDA and DOJ.
We have extensive experience in defending health professionals nationally who are faced with criminal charges, including:
We represent licensed medical professionals across the U.S., including:
Our offices are in Detroit (where we serve Dearborn, Troy, Ann Arbor and Grand Rapids, and the rest of Michigan); Miami and Sarasota, Florida (for Jacksonville, Tampa, Orlando, West Palm Beach, and all of Florida); Los Angeles/Southern California; and Chicago. Contact us today to learn more.
Ronald W. Chapman Sr., M.P.A., LL.M.
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The National Healthcare Criminal Law Attorneys at Chapman Law Group Explain How Medicaid Fraud Investigations are Handled Medicaid provider fraud is a unique focus area
Ron W. Chapman Ronald W. Chapman Sr., the founder of Chapman Law Group, speaking at Corizon Health Annual Statewide Conference May 16th at 5:00pm-6:00 pm
On June 18, 2015, the Department of Justice (DOJ) announced a $712 million Medicare fraud takedown by the Medicare Fraud Strike Force. It is the
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