All About Medicaid Fraud Defense, from Our National Healthcare Criminal Lawyers

Older Medical Records File Cabinet

When Your License, Reputation, and Livelihood are at Stake Due to Medicaid Fraud Allegations, We Are Here to Protect You

Local governments have dedicated a considerable amount of resources to the investigation and prosecution of Medicaid fraud in recent years. Many states even award patients and staff who file Medicaid fraud Qui Tam (or whistleblower) lawsuits up to 30% of the recovered money.

Unfortunately, this has caused many healthcare providers to be subject to investigations relating to smaller billing errors or discrepancies. The national Medicaid fraud defense lawyers at Chapman Law Group have helped many medical professionals in the Metro Detroit area, Florida, and across the U.S.

Medicaid Audits and Investigations

Medicaid audits are conducted by state agencies 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, whistleblower or Medicaid plan.

Auditors may conduct an onsite audit or an offsite records audit (also called a desk audit). Auditors use several different fraud and overpayment detection methods. Common methods include data mining, where state analysis’s sort claims through statistical models to identify outliers. Other methods include evaluating a provider’s claims against similar providers within the same geographic region.

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.

Therefore, we advise that you seek assistance from an attorney if you are subject to a Medicaid audit or investigation. Our Medicaid fraud attorneys and Medicaid claims compliance specialists will work with you to prepare for the audit or investigation and work with the authorities during the investigation to protect your interests.

If you are a doctor who is in this situation, we will work with you to ensure you submit sufficient information to support your claims and reimbursement to help avoid overpayment demands. Depending on the facts of the case, we may be able to prevent criminal charges from being filed and avoid licensing action or overpayment action.

Medicaid Fraud Actions

Providers suspected of fraud or a false claim can face both criminal and civil charges for Medicaid fraud. Unlike other health law matters, Medicaid fraud cases often progress very quickly and have devastating consequences, if not handled properly and timely.

Often, Medicaid fraud cases are assigned to special prosecutors who are very experienced in fraud and abuse laws. Therefore, providers accused of Medicaid fraud should retain an attorney who is exceptionally experienced in handling Medicaid fraud matters and do so at the earliest opportunity.

Our team of Medicaid fraud defense attorneys includes a former Medicaid fraud prosecutor who is exceptionally experienced in both criminal and civil Medicaid fraud matters. We assist providers with Medicaid audits, investigations, overpayment actions, and civil and criminal actions related to Medicaid fraud.

Our Medicaid fraud team also includes a former Medicare lawyer who is highly knowledgeable in Medicare audits, fraud detection and overpayment actions. We are dedicated to assisting health care providers during audits, fraud investigations and Medicaid fraud actions, and are capable of handling the most complex Medicaid fraud cases.

If a Medicaid fraud lawsuit has been filed against you, our Medicaid fraud attorneys and Medicaid claims compliance professionals will work with you to prepare your defense and protect your interests. Depending on the facts of the case, we may aim to have the case dismissed, or if the evidence is against you, work to achieve a favorable settlement and limit the impact on your career.

Common Types of Medicaid Fraud

    • False invoicing
    • Billing for services not provided
    • Billing for equipment not provided
    • Overutilization of certain medical procedures or services
    • Billing unbundled services

Possible Medicaid Fraud Sanctions

  • Criminal charges
  • Expulsion from the Medicare / Medicaid Program
  • Licensing Action
  • Loss of Staff Privileges
  • Inability to collect outstanding invoices
  • Fines and costs
All Medicare and Medicaid fraud audits have the potential to evolve into criminal indictments, as well as civil recovery complaints and state professional licensing complaints. All of these potential situations have the capability of causing you long-term harm, including jail time, large fines, professional license suspension and even revocation.

Turn to Chapman Law Group, Your Best Choice for Medicaid Fraud Defense Across the U.S.

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, including your license, your standing with your employer, your reputation with your peers and your continued inclusion in the Medicaid and Medicare programs. We not only work to defend you against Medicaid fraud charges, but also work to limit the impact that such charges will have on the many facets that affect your career.

A Medicaid fraud defense lawyer at Chapman Law Group will work together with our licensing and health law attorneys to prevent and/or resolve subsequent matters following fraud allegations, such as licensing, credentialing and CMS enrollment matters. 

We represent licensed healthcare professionals across the U.S., from physicians, chiropractors, and mental health professionals, to pain management specialists, pharmacists and dentists.

Our national health care fraud and healthcare-based criminal defense law offices are in Miami and Sarasota, Florida; Detroit, Michigan; and Los Angeles/Southern California. Contact us today for more information.

Need an Attorney? Contact us now!


  • This field is for validation purposes and should be left unchanged.


  • This field is for validation purposes and should be left unchanged.

Got A Question?

Contact me now to schedule a consultation.

Other Practice Areas

Health Care Fraud/
Criminal Defense

Related Case Results

Related Blog Posts

FREE Health Care Newsletter

Stay up to date on the latest news in health care law!

FREE eBook!

Click the link below to download our compliance eBook now!
Chapman Law Group Favicon

This website uses cookies to ensure you get the best experience on our website.

Send this to a friend