Defending Medicaid Fraud Charges

Medicaid fraud costs taxpayers millions of dollars every year. The assortment of crimes involving Medicaid Fraud are all based on misrepresentations and/or false information that is provided in order to collect Medicaid payments. It might occur as organizations or individuals bill Medicaid for services that were never provided, it could involve making changes in billing codes to get reimbursed for more expensive services, or it might even be a matter of manipulating data in order to get kickbacks. The crimes are costly, as are the penalties for a conviction.

What Constitutes Medicaid Fraud?

Intentionally defrauding any health care benefit program violates federal statute. In fact, even purposely ignoring the truth in these matters can lead to criminal charges. There is no “head in the sand” defense. There are myriad ways in which Medicaid fraud occurs. The following crimes occur most commonly:

• Failing to properly document and return any mistaken overpayments from Medicaid within 60 days of discovering the problem;
• Providing false personal information as a way to participate in Medicaid;
• Providing contrived or false information in an attempt to influence discharge decisions for a hospital patient;
• Turning in claims to Medicaid for materials, procedures, or services that a patient either did not receive or did not need;
• Performing one service, but billing for a more expensive one;
• Double billing two entities– such as Medicaid and another insurance company or the patient–for the same procedure;
• Paying money accepting money in exchange for referrals;
• Billing separately and at higher prices for services that should be combined into one lower rate;
• Neglecting to conduct sufficient medical screening for women who are in labor or experiencing another emergency in a hospital emergency room;
• Misappropriating health care providers’ medical numbers or other identifiers;
• Buying or selling Medicaid numbers;
• Obtaining medical services or funds using someone else’s Medicaid name and number.

Penalties for Medicaid Fraud

Anyone facing charges of Medicaid fraud is looking the possibility of significant penalties that could include:

• Being put on the Office of Inspector General’s exclusion list and losing the opportunity to work with all federal government health care programs, including both Medicaid and Medicare, which could be career-ending for someone in the medical world;
• Losing one’s professional license, which is another serious problem for nurses, physicians, pharmacists, and others;
• Having the government seize assets linked to the crime, from vehicles and other property to bank accounts;
• Receiving civil fines of up to $27,000 per infraction, along with triple the loss to the Medicaid program;
• Getting criminal fines of as much as $250,000;
• Being imprisoned for up to ten years per count.

Fighting for You

The experienced Miami criminal defense attorneys at The Law Office of Julia Kefalinos appreciate the seriousness of these charges and understand just how devastating a conviction can be. We will fight to safeguard your rights and to achieve the best possible outcomes. To discuss, schedule a confidential consultation in our Miami office today.