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 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.
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.
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 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 for more information.
Our healthcare criminal lawyers’ in-depth knowledge of addiction medicine allowed our physician client to have the best possible chance at acquittal.
Following review of our physician’s compliance plan, the government choose to dismiss the investigation without taking any adverse action.
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