About Medicaid Fraud Defense
The stated goal of the NC Medicaid Office of Compliance and Program Integrity (OCPI) is to stop fraud, waste, and abuse in Medicaid.
What that sometimes means, however, is that well-meaning professionals have to respond to audits and investigations that are time-consuming and expensive.
The process sometimes makes people question why they participate in the programs in the first place.
You do not and should not face Medicaid fraud investigations or accusations alone. Our attorneys are prepared to assist you every step of the way.Contact Us
Audits, investigations, or litigation related to Medicaid
More than one medical professional has concluded that the government does not always make it easy to do the right thing.
Whether accurate or not, we cannot blame a person for feeling frustration when faced with an audit, investigation, or litigation related to Medicaid billing practices from feeling that way.
The program is designed to help people who have difficulty affording medical services. The rates for services are not always equal to the rates paid by private insurance or individuals who can afford out of pocket medical expenses. Yet, medical and dental practitioners are held to a high standard and expected to account for every procedure.
While the government should hold professionals accountable for the use of taxpayers’ money, the paperwork and regulations can seem overwhelming at times.
The stated goal of the NC Medicaid Office of Compliance and Program Integrity (OCPI) is to stop fraud, waste, and abuse in Medicaid. What that sometimes means, however, is that well-meaning professionals have to respond to audits and investigations that are time-consuming and expensive. The process sometimes makes people question why they participate in the programs in the first place.
We understand these feelings and have counseled professionals facing investigations, civil litigation, and criminal charges related to allegations of Medicaid fraud. The process is scary. It can damage your reputation as a medical provider, undermine your integrity, and put your economic and personal liberty in danger.
What you can do about a Medicaid investigation
You do not and should not face these investigations or accusations alone. We are prepared to assist you every step of the way. While every situation is different, we have experience evaluating the complex structure surrounding Medicaid benefits and payments, have relationships with experts to assist with your defense, and are prepared to defend you in civil litigation and against criminal charges.
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. That means suspicion of Medicaid fraud is often investigated by the state, as opposed to the federal government.
One simple method of Medicaid fraud is when a person fails to report all their income in order to qualify for Medicaid. Mistakes in reporting can lead to allegations of Medicaid or a request by the Office of Compliance & Program Integrity for repayment of any Medicaid benefits. Because those benefits add up over time, a simple mistake could lead to pressure to repay the state for Medicaid benefits.
You should consult with qualified legal counsel before entering any negotiation with the Office of Compliance & Program Integrity. We have assisted clients in these situations and can help you.Request Consultation
What leads to a Medicaid fraud investigation?
Failing to report private insurance can lead to an investigation into Medicaid fraud by the Office of Compliance & Program Integrity. It is critical to consider all questions on any application carefully and disclose privately funded insurance. More important, be sure to contact counsel if an investigator contacts you during an investigation into a Medicaid application. We are happy to assist.
Using a Medicaid recipient’s Medicaid card could get the user and the recipient in trouble with the state. When the card is used with the recipient’s knowledge, both parties could be investigated and prosecuted civilly and criminally for Medicaid fraud.
Another category of Medicaid fraud involves investigations into the practices of medical and dental providers. These include allegations that a provider’s credentials are inaccurate, that the provider billed for services that were not rendered, or that the provider billed for services that were not medically necessary. Sometimes all these violations are alleged against a single provider.
These investigations can be highly technical, detailed, and time-consuming. Investigators may choose to review the details of medical records to compare to the treatment a person received. They may request supply records to compare against supplies listed on the bills. These investigations often result in a review of volumes of records, multiple interviews with the patients, and a comparison of the records and the interviews. Sometimes potential witnesses are examined under oath.
We have advised many people during investigations, represented witnesses forced to appear before grand juries, and helped clients prepare for imminent charges. We understand the exposure you face and can help you navigate this difficult process.
Counsel must be prepared to analyze this information and consider alternatives to willful conduct as well take into consideration and offer explanations for lawful behavior.
We have advised people during these investigations, consulted experts, and defended claims of criminal wire fraud.
We understand the monumental task of gathering documents for an independent review, the worry associated with not knowing where the government’s investigation will lead, and the danger of losing everything you have worked for. We are prepared to help you challenge these investigations and defend you at trial when necessary.
We understand you risk losing everything as a result of a Medicaid fraud investigation.
We are white-collar criminal defense attorneys prepared to help you achieve your best possible results and get back to leading a productive life.