Health Insurance Fraud Defense

The government dedicates a considerable amount of resources to the investigation and prosecution of Medicaid fraud. Unfortunately, this causes many healthcare providers to be subjected to investigations relating to small billing errors or minor discrepancies. The Medicaid fraud attorneys at Leichter Law Firm, PC have helped many medical professionals in the Austin, Texas area, as well as across the United States.

Health Insurance and Medicaid Fraud Attorney

According to the U.S. Government Accountability Office, about $1 out of every $7 to Medicare is lost due to insurance fraud and abuse. As a whole, insurance fraud may involve up to $100 billion in stolen funds each year. Because of the widespread nature of the problem, charges of fraud and abuse against physicians and other health care providers can have serious consequences. If you have been charged with health insurance fraud and now face the risk of losing your professional license, the Texas professional license defense lawyers at the Leichter Law Firm have the knowledge and experience you need to help you build the strongest defense possible. Contact our offices today at 512-495-9995 to discuss your situation.

Examples of Health Insurance Fraud

The most commonly-reported type of health insurance fraud is a false claims scheme. Any of the following actions, if performed fraudulently, could be considered health insurance fraud:
  • Ordering tests or performing services that are unnecessary
  • Billing for services or procedures that were not rendered
  • Misrepresenting a condition or a service
  • Duplicating charges
  • Receiving kickbacks or other benefits for referrals

Individual states determine how much Medicaid will be paid, usually on a contingency fee basis. Claims can be review up to three years after the date they were filed.

A Medicaid fraud attorney assists physicians and healthcare professionals when a complaint has been filed against them, whether by a patient, whistleblower, or another internal agency discrepancy.

Medicaid Fraud Control Units, or MFCUs investigate and also prosecute Medicaid fraud on the provider’s side. They also prosecute patient abuse or neglect in health care facilities and board and care institutions.

Individual states determine how much Medicaid will be paid, usually on a contingency fee basis. Claims can be review up to three years after the date they were filed.

MFCUs use data and statistics that recognize over and under coding incidents. If your practice falls outside of what they consider “normal”, you are more than likely to receive a Medicare audit. Also, excessive modifiers can also increase your risk. Another common reason for Medicaid audits include patient complaints and disgruntled employees.

According to CMS, CERT audits use a valid random sample of claims. Auditors review the selected claims to determine whether they were paid properly under Medicaid coverage, coding and billing rules. If you’re being audited by Medicaid or Medicare, or any health insurance agency, for that matter, you’ll want to hire a health insurance fraud attorney.

Medicaid fraud prosecuted at the state level can be a felony or misdemeanor. It depends on the state law. In Texas, healthcare fraud can range from misdemeanor to a felony offense. 

Get in Touch

Office Locations

Austin Office

1602 E 7th St
Austin, TX 78702
Phone: (512) 495-9995
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Houston Office

3700 N Main St
Houston, TX 77009
Phone: (713) 714-2446
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McAllen Office

214 N 16th St #128
McAllen, TX 78501
Phone: (956) 205-0884
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Hire a Medicaid Fraud Attorney for Audits and Investigations

Medicaid audits are conducted by state agencies for the purposes of determining compliance, overpayments, and to look for evidence of Medicaid fraud on behalf of a physician. Often, Medicaid audits are conducted in response to a complaint from a patient, whistleblower or Medicaid plan. Auditors may conduct an onsite audit or an offsite audit, called a desk audit. They will use several fraud and overpayment detection methods, including but not limited to: data mining, evaluating claims against similar providers in your region, and if they suspect fraud, they’ll refer to Medicaid Fraud Control Unit (MFCU). These audits cam result in tens of thousands of dollars in overpayment demands, false claim charges and anti-kickbacks. So, we advise you seek assistance from a Medicaid fraud attorney if you have reason to believe you may be subject to a Medicaid audit or investigation.

Common Types of Medicaid Fraud

  • False invoicing
  • Billing for un-provided services or equipment
  • Overutilization of certain medical procedures or services
  • Billing unbundled services

Possible Medicaid Fraud Outcomes

Medicare, FMHP, and Insurance Audits

Because of increased allegations of fraud in the medical field, healthcare professionals are under more scrutiny than ever, and regulators are extremely quick to issue notices of “overpayment” and investigate billing practices and services rendered. If you are in the healthcare field, you know that going through a Medicare, Medicaid, FMHP, or insurance audit can be one of the most frustrating, time-consuming, and disruptive experiences imaginable. Fortunately, at the Leichter Law Firm PC, we are ready to handle this process for you to ensure that no procedural errors are made that could elongate this already frustrating process, and to allow you more time to focus on those parts of your job that matter most. While you are not required to have an attorney help you through the appeals process, the reality is that this experience is extremely complex and confusing. As such, you want to make sure that you have an experienced healthcare audit attorney on your side to make sure that everything is handled correctly and as efficiently as possible. A professional charged with committing any of these actions could be held liable for defrauding or abusing a health insurance company, and may be at risk of losing his or her practitioner’s license.

Contact the Health Insurance, Medicare and Medicaid Fraud Attorneys at Leichter Law Firm

If you have been accused of committing health insurance fraud and are in danger of losing your professional license, the Texas professional license defense attorneys at the Leichter Law Firm can help you build a strong case and defend your practice and your reputation. Contact our offices today at 512-495-9995.