In a recent article Stateline spoke with Summer McKeivier as part of its coverage of fraud concerns tied to Medicaid and the broader strain those issues place on government healthcare programs. A Shareholder at Chapman Law Group, Summer brings the perspective of a federal healthcare fraud defense attorney whose practice includes representing providers in criminal cases, government investigations, and other high-stakes matters involving Medicare and Medicaid. Her comments speak directly to a problem many healthcare professionals understand all too well: working within systems that are heavily regulated, constantly changing, and subject to intense scrutiny.
Federal scrutiny of Medicaid fraud has increasingly extended beyond individual providers to the states responsible for administering these programs and overseeing how public healthcare dollars are spent. For healthcare professionals, that matters because increased enforcement at the state level can quickly lead to audits, payment disputes, billing reviews, and fraud allegations involving the providers who participate in Medicare and Medicaid. As a result, providers can find themselves facing serious legal and professional consequences even before the underlying facts are fully developed.
Summer’s contribution to that discussion was clear. “Medicaid is so large and involves so much money, it is inevitable that there will be bad actors and there will be fraudulent activity,” she said. At the same time, she underscored how easily providers can find themselves exposed when the rules are difficult to follow and aggressively enforced, adding, “The issue there is that the federal government and state government, in my opinion, are what I would consider the biggest loan sharks that we have in the world. Basically, they always want their money back,” and, “The real problem, the overarching problem with both programs (Medicaid and Medicare), is that they are highly complicated and constantly evolving and changing.”
Healthcare fraud cases involving Medicare and Medicaid are rarely limited to outright theft or obvious misconduct. More often, they grow out of questions about billing, coding, documentation, medical necessity, reimbursement, or whether a service was properly covered under a program’s rules. That is what makes these cases so important for healthcare professionals. When federal healthcare programs are large, heavily regulated, and constantly changing, providers can find themselves under scrutiny even when the underlying issue is whether a claim was handled correctly, interpreted correctly, or supported in the way the government expects.
For providers, the risk is not just financial. A Medicare or Medicaid fraud issue can lead to payment suspensions, recoupment efforts, government investigations, licensing concerns, potential jail time, and serious damage to a professionals reputation. That is why these matters deserve careful attention from anyone who participates in federal healthcare programs. In an environment where enforcement can move quickly and the rules are not always easy to follow, healthcare professionals need to understand that billing and compliance issues can escalate significantly if they are not addressed early and properly.
When a healthcare professional faces scrutiny involving Medicare or Medicaid, it is important to work with counsel who understands both federal criminal defense and the realities of the healthcare industry. Chapman Law Group represents providers in healthcare fraud cases, government investigations, and other high-stakes matters involving billing, reimbursement, prescribing, and program compliance. Summer McKeivier brings that experience to these cases as a Shareholder of the firm, and head of our White-Collar Criminal Defense division. For healthcare professionals whose careers, reputations, and livelihoods may be on the line, experienced legal guidance matters. If you find yourself in the midst of an audit, under a federal investigation, or want to get ahead of the government by making sure your practice is in compliance with federal guidelines, contact Chapman Law Group today for a free consultation with one of our healthcare fraud defense attorneys.
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