Navigating Medicaid Fraud Charges

 Posted on February 14, 2024 in Criminal Defense

Facing criminal charges related to Medicaid fraud can be an incredibly frightening and confusing ordeal. For those confronted with Medicaid fraud allegations or charges, arming yourself with key knowledge on common offenses, penalties, defense strategies, and possible negotiating outcomes with prosecutors can help you navigate this legal storm. Having a Texas criminal defense lawyer on your side is beneficial with your reputation on the line.

What Are the Most Frequent Medicaid Fraud Offenses Alleged?

While improper billing practices like charging for services never performed represents classic Medicaid fraud, other common allegations include upcoding services to receive higher reimbursements, billing separately for care bundles in an unallowed practice called unbundling, billing for unnecessary tests and procedures, referring patients to medical companies you own for self-serving financial gain, or using a patient or colleague’s Medicaid ID number without authorization to submit false claims. Even inadvertent billing errors can prompt fraud accusations and charges.

What Potential Penalties Are Faced?

Medicaid fraud convictions can lead to 5-10 years in federal prison, tens of thousands in civil fines and penalties, and exclusion from participating in federal healthcare programs like Medicare and Medicaid. The mere accusation threatens your medical license, practice, and professional reputation, even if charges are eventually dismissed. These substantial criminal, financial, and professional penalties demonstrate exactly why fighting fraud allegations from the earliest stages is vital.

Can Medicaid Fraud Charges be Effectively Fought?

Medicaid fraud charges can be challenged and defeated, but acting quickly and having an adept attorney fighting for you is essential. An experienced defense lawyer’s deep knowledge of the complex billing and coding nuances allows them to examine records and identify deficiencies in the prosecution’s claims and evidence. They understand how to negotiate with investigators, highlight procedural problems, and bring in specialty experts to evaluate billing justification and medical necessity.

What Defense Strategies are Employed?

An effective defense will be multi-layered. Showing that records and billings reflect care legitimately delivered can undermine prosecution assertions. Presenting proof of your diagnosis methods and the reasoning behind the tests ordered can invalidate allegations around unnecessary services. Your lawyer might also demonstrate:

• Billing errors were mistakes, not intentional deception
• Patients had complex conditions justifying billing
• You had no financial conflicts of interest
• Auditors misinterpreted context within records
• Coding challenges reasonably contributed to errors

Can Charges Be Settled Without a Trial?

Charges may be resolved through agreements like entering pretrial diversion programs, allowing you to avoid the stigma of a fraud conviction if completing the program terms. Your lawyer can also negotiate repayment plans for incorrectly paid funds as another means to settle allegations. Outcomes rely on the defense evidence and the prosecutor’s willingness to bargain.

Contact a Dallas, TX Criminal Defense Attorney

Facing Medicaid fraud charges threatens far more than your practice. Your future hangs in the balance. A Fort Worth, TX criminal defense lawyer fighting for you from the initial stages allows you to defend your case best. Call The Crowder Law Firm, P.C. at 214-544-0061 for a free consultation.