Medicare / Medicaid Fraud Defense Lawyers In Royal Oak
Health care fraud allegations can devastate medical practices and individual providers. When federal investigators target you or your practice for Medicare or Medicaid billing irregularities, the consequences can be severe and far-reaching. At Law Offices of Barry A. Resnick, PLLC, Barry A. Resnick brings over 50 years of experience defending health care providers throughout Royal Oak and Michigan.
We understand the complex regulations governing federal health care programs and how prosecutors build these cases. Mr. Resnick’s team provides strategic defense when your professional reputation, financial security and freedom are at stake.
Types Of Medicare / Medicaid Fraud Allegations
Understanding what actions might trigger an investigation is essential for health care providers. Federal prosecutors pursue various forms of alleged health care fraud, including:
- Billing fraud: Submitting claims for services never provided, upcoding to higher reimbursement levels or improperly unbundling services
- Kickbacks: Receiving payments for patient referrals or prescribing specific medications or treatments
- Phantom patients: Creating fictional patient records to bill for non-existent services
- Medical necessity issues: Billing for services deemed not medically necessary
- Identity theft: Using patient or provider information to submit fraudulent claims
Both Medicare billing fraud and Medicaid billing fraud investigations often involve allegations that violate the Anti-Kickback Statute, which prohibits offering or receiving anything of value to induce referrals for services covered by federal health care programs.
Who May Be Targets?
Federal health care fraud investigations can target anyone involved in the health care system, including:
- Physicians and medical practices
- Home health agencies
- Pharmacies and pharmaceutical companies
- Durable medical equipment providers
- Individual health care workers
- Patients allegedly involved in fraudulent schemes
We defend clients facing federal health care fraud allegations throughout Detroit and surrounding Michigan communities, providing experienced representation when government investigators come knocking.
How Do Federal Agencies Investigate Suspected Medicare And Medicaid Fraud?
Recognizing the government’s methods can help you respond appropriately if targeted. Health care fraud investigations typically begin through:
- Whistleblower complaints from current or former employees
- Computer analysis identifying unusual billing patterns
- Patient complaints about suspicious charges
- Competitor reports
Multiple agencies may participate, including the Department of Health and Human Services Office of Inspector General, the FBI, and state Medicaid Fraud Control Units. Warning signs of an investigation include unusual audit requests, unannounced site visits, or subpoenas for patient records. As experienced Medicaid fraud lawyers, we advise contacting us immediately if you suspect you’re under investigation, before speaking with investigators.
What Constitutes Medicare Or Medicaid Fraud Under Federal Law?
Federal law, particularly the False Claims Act, prohibits knowingly submitting false claims to government health care programs. The key element prosecutors must prove is intent–that you knowingly submitted improper claims rather than made honest mistakes.
Many health care providers face False Claims Act defense challenges when documentation errors or coding misunderstandings are mischaracterized as intentional fraud. The government must demonstrate that you deliberately misrepresented facts when billing federal programs, not simply that errors occurred.
What Are The Penalties For Health Care Providers Convicted Of Medicare / Medicaid Fraud?
The stakes in health care fraud cases cannot be overstated. Medicare fraud penalties are severe and multifaceted:
- Criminal penalties: Prison sentences often ranging from 5-10 years per count
- Financial penalties: Fines up to three times the amount billed plus additional penalties per claim
- Exclusion: Permanent or temporary exclusion from participation in Medicare, Medicaid and other federal health care programs
- Professional consequences: Loss of medical licenses and hospital privileges
- Reputational damage: Public reporting of allegations even before conviction
These penalties underscore the importance of health care fraud defense from the investigation’s earliest stages.
Our Approach To Protecting Clients
We develop customized defense strategies based on the specific allegations and evidence in your case. Our approach to defending health care providers includes:
- Challenging the government’s evidence of fraudulent intent
- Addressing documentation and compliance issues proactively
- Negotiating with prosecutors before formal charges
- Developing robust compliance programs to prevent future issues
We also defend health care providers facing related allegations such as PPP loan fraud. As your medical billing fraud defense team, we work to protect your practice and professional standing. Our health care compliance attorneys understand both the legal and medical aspects of these cases, giving our team of Medicare fraud defense attorneys unique insight into effective defense tactics.
Our Firm Is Ready To Advocate For You
If you are in the crosshairs of a health care fraud investigation, then you may very well need legal protection. Contact Law Offices of Barry A. Resnick, PLLC, through this contact form or call us at 248-419-1035 for a confidential consultation. We’ll help you understand your options and develop a strategic defense plan.