Health care fraud occurs when providers knowingly submit claims to Medicare or Medicaid for products or services that were never provided or were not medically necessary. Federal and state agencies aggressively investigate doctors, pharmacists, ambulance companies, hospitals and clinics for possible fraud with a growing focus on criminal violations.
If you’re facing Medicare or Medicaid fraud charges, you need a dedicated legal team that understands the intricacies of these complex cases. Look no further than Hilder & Associates, a Houston, Texas-based law firm renowned for providing unparalleled defense representation against Medicare and Medicaid fraud allegations. With a proven track record and national representation capabilities, we are here to safeguard your rights, reputation, and future.
Defending Those Accused of Medicare & Medicaid Fraud
At Hilder & Associates, we have an in-depth understanding of the multifaceted realm of Medicare and Medicaid fraud cases. Our seasoned attorneys specialize in offering a robust defense against a wide array of fraud-related charges, including:
- Billing Fraud: We provide unwavering defense to healthcare professionals and organizations accused of submitting false claims or inflating billings to government healthcare programs.
- Kickbacks and Bribes: Our adept legal team represents clients facing allegations of illegal financial inducements, such as kickbacks and bribes, in connection with referrals or services.
- False Certifications: We advocate on behalf of individuals who have been accused of providing false information to qualify for Medicare or Medicaid benefits.
- Unnecessary Procedures: Our attorneys are skilled at defending against accusations of performing medically unnecessary procedures to boost reimbursement rates.
- Patient Identity Theft: We safeguard clients who are accused of wrongfully using patient identities to bill government programs for services that were never actually rendered.
- Healthcare Provider Fraud: Our strategic defense encompasses healthcare providers facing allegations that compromise the integrity of government healthcare programs.
At Hilder & Associates, P.C., we are dedicated to protecting the rights of medical professionals dealing with an investigation and facing possible criminal litigation over Medicaid and Medicare fraud charges.
Medicare and Medicaid Kickback Violations
Medicare and Medicaid kickbacks in relation to fraud involve illicit practices within the healthcare industry that can defraud these government healthcare programs. These fraudulent activities often entail the exchange of unlawful financial incentives or remuneration in an attempt to manipulate patient referrals, medical decisions, or billing processes. Here’s how Medicare and Medicaid kickbacks relate to healthcare fraud:
Referral Kickbacks: One common form of healthcare fraud involving these government programs is the offering or acceptance of kickbacks in return for patient referrals. For example, a healthcare provider might receive a kickback in exchange for referring Medicare or Medicaid patients to a specific laboratory, hospital, or pharmacy. These arrangements can lead to unnecessary medical services, inflated claims, and increased program costs, constituting fraud.
Billing Fraud: Kickbacks can also be used to perpetrate billing fraud. Healthcare providers may engage in fraudulent practices such as upcoding (billing for more expensive services than provided) or unbundling (billing separately for services that should be billed together) to maximize reimbursement from Medicare or Medicaid. In some cases, kickbacks may be involved in orchestrating these fraudulent billing schemes.
Improper Financial Relationships: Healthcare entities and professionals receiving improper financial incentives to order or prescribe certain medications, devices, or services can result in overutilization of Medicare and Medicaid resources, leading to financial losses and compromising patient care.
Kickback Schemes: Complex kickback schemes can involve multiple parties within the healthcare industry, including physicians, hospitals, pharmaceutical companies, and patient recruiters. These schemes may be designed to exploit weaknesses in the system and defraud government programs.
Whistleblower Claims: Medicare and Medicaid fraud, including kickbacks, are often exposed through whistleblower claims, where individuals with insider knowledge of fraudulent activities report them to authorities. These claims can lead to investigations, prosecutions, and the recovery of fraudulently obtained funds.
Medicare and Medicaid kickbacks, when used to manipulate patient referrals, billing practices, or financial relationships within the healthcare industry, can constitute healthcare fraud. Healthcare fraud not only results in financial losses to these government programs but also undermines the quality and integrity of healthcare services provided to vulnerable populations. It is crucial for healthcare providers and organizations to adhere to strict compliance standards and for individuals facing allegations of Medicare and Medicaid fraud, including kickbacks, to seek legal representation to navigate the complexities of these cases.
Facing a Medicare or Medicaid Audit
Criminal prosecutions may blossom from an administrative audit of a provider. For example, a Medicare auditor may look closely at a sample of patients and determine that their billed treatment was not medically necessary. An unsuccessful review could trigger a further inquiry, an appeal process, suspension of the provider’s Medicare or Medicaid number, reimbursement for loss or even criminal prosecution.
A provider receiving an audit letter or who is indicted for Medicaid and Medicare fraud should immediately consult with a health care fraud attorney adept at investigating and advising medical providers. A successful administrative review could remove the provider from the government’s radar, thus it is critical to follow the administrative process. Providers may be exposed to severe penalties, including millions in damages, years in prison and forfeiture of assets.
When undergoing a Medicare or Medicaid audit, it is important to follow these steps:
1. Receiving an Audit Letter or Indictment: When a healthcare provider receives an audit letter or is indicted for Medicaid and Medicare fraud, it signifies that the government suspects irregularities or fraudulent activities in their billing practices or other aspects of their operations. This is a serious matter that demands immediate attention.
2. Consulting a Health Care Fraud Attorney: A health care fraud attorney is experienced in defending individuals and entities facing allegations of healthcare-related fraud. These attorneys possess a deep understanding of healthcare regulations, billing practices, and legal intricacies related to Medicare and Medicaid programs. Consulting with such an attorney is crucial to navigate the complexities of the legal process and mount an effective defense.
3. Importance of Investigation and Advising: A skilled health care fraud attorney will investigate the allegations thoroughly. This involves scrutinizing billing records, patient data, and other relevant documentation to assess the accuracy of the charges. The attorney will also advise the provider on the best course of action, whether it involves engaging in negotiations, preparing for trial, or pursuing an administrative review.
4. Administrative Review Process: An administrative review is a formal process that allows healthcare providers to challenge audit findings or allegations of fraud through the administrative channels provided by the government agencies overseeing Medicare and Medicaid. A successful review can lead to a resolution without the need for litigation, potentially removing the provider from the government’s radar.
Penalties for Medicare or Medicaid Fraud
Penalties for Medicare or Medicaid fraud can be severe, reflecting the serious nature of the offense and the potential financial harm to government healthcare programs. These penalties can vary depending on factors such as the specific charges, the amount of financial loss, the defendant’s criminal history, and the jurisdiction where the case is prosecuted. Here are some common penalties associated with Medicare or Medicaid fraud:
Criminal Charges: Individuals or entities charged with Medicare or Medicaid fraud can face various criminal charges, including healthcare fraud, wire fraud, mail fraud, conspiracy, and making false statements.
Fines: Fines are a common penalty for Medicare and Medicaid fraud convictions. The fines can range from thousands of dollars to millions, depending on the extent of the fraud and the financial losses incurred by the government programs.
Restitution: Courts often order convicted individuals to pay restitution to the government programs for the amount of money that was fraudulently obtained. This is meant to compensate the programs for the financial losses suffered due to the fraud.
Imprisonment: Individuals convicted of Medicare or Medicaid fraud can face substantial prison sentences. The length of imprisonment depends on the severity of the offense. Sentences can range from a few years to several decades in federal or state prison.
Exclusion from Programs: Convictions for healthcare fraud can result in exclusion from participating in Medicare, Medicaid, and other federal healthcare programs. This can have significant professional and financial consequences for healthcare providers.
Asset Forfeiture: Courts may order the forfeiture of assets that were gained through the fraudulent activities. This can include money, property, or other assets acquired using the proceeds of the fraud.
Civil Monetary Penalties: In addition to criminal penalties, individuals and entities found liable for healthcare fraud may also face civil monetary penalties imposed by the government. These penalties are meant to deter future fraudulent activities.
Professional Consequences: Healthcare professionals convicted of Medicare or Medicaid fraud may face license suspension or revocation, as well as damage to their professional reputation.
Legal Fees: Defendants are typically responsible for covering their legal fees associated with their defense. Legal representation in healthcare fraud cases can be complex and costly.
Impact on Reputation: Convictions for Medicare or Medicaid fraud can lead to damage to personal and professional reputation, making it difficult to secure future employment in the healthcare industry.
It’s important to note that federal and state laws can vary, and penalties can be influenced by a range of factors. If you’re facing charges of Medicare or Medicaid fraud, seeking experienced legal representation is crucial to navigate the complexities of the legal process and protect your rights and interests. An attorney can assess your case, develop a strong defense strategy, and work toward the best possible outcome given the circumstances. Secure the advocacy you need and the protection of the rights you deserve.
Why Choose Hilder & Associates
Proven Success: The history of successful outcomes achieved by our firm in Medicare and Medicaid fraud cases is a testament to our legal acumen and innovative defense strategies.
Knowledgeable: Our attorneys possess an intricate understanding of the healthcare industry, including the intricate regulations surrounding Medicare and Medicaid programs. We tailor our defense strategies to suit the unique circumstances of each case.
Nationwide Representation: Though headquartered in Houston, Texas, we extend our expert legal representation to clients across the nation. Our attorneys are well-equipped to handle cases in federal and state courts throughout the United States.
Comprehensive Investigations: We collaborate with experts in healthcare regulations, accounting, and digital forensics to conduct thorough investigations, unearth critical evidence, and expose vulnerabilities in the prosecution’s case.
Strategic Negotiation: While we are always prepared for trial, our negotiation skills are adept. We strive to secure favorable settlements whenever possible, with the ultimate goal of minimizing the impact of the legal process on your personal and professional life.
Client-Centered Approach: At Hilder & Associates, we prioritize your well-being. With personalized attention, transparent communication, and steadfast support, we ensure you are guided through every step of your legal journey.
Facing allegations of Medicare or Medicaid fraud can be an overwhelming experience. Reach out to Hilder & Associates today to arrange a confidential consultation. Our team of dedicated attorneys is poised to listen, assess your case comprehensively, and offer the strategic legal guidance needed to navigate the complexities of these allegations. Your rights, reputation, and future are our topmost priorities.
Committed to Protecting Your Future
A simple administrative audit can grow into a complex criminal case, requiring you to have an experienced Houston health care fraud attorney at your side. Contact Hilder & Associates, P.C. online or over the phone at 713-234-1416 or toll-free at 888-659-8742