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Is Medicaid Fraud a Federal Offense?

Medicaid fraud is one of the most common forms of health care fraud. The Texas Attorney General defines Medicaid and health care fraud as “a deliberate deception or misrepresentation of services that results in unauthorized reimbursement.” Any health care practitioner who bills Medicaid is subject to charges of Medicaid fraud, including doctors, pharmacists, laboratories and more. A Medicaid offense may be either a state or federal offense, or both, depending on the alleged violation(s).

What Are Examples of Medicaid Fraud?

A few examples of Medicaid fraud are:

  • A doctor bills Medicaid for services that were not provided, like blood tests and X-rays.
  • A doctor falsifies a patient’s diagnosis, in an attempt to justify unnecessary tests.
  • A doctor bills Medicaid for a more expensive service than the one that was provided.
  • An ambulance service charges for transporting a patient to a hospital when it is not medically necessary.
  • A pharmacist fills a prescription with a generic drug but bills Medicaid for the brand name drug.
  • A doctor or other health services provider charges for care not given. In some cases, the patient to whom services were allegedly provided was actually dead.
  • Billing separately for services provided that are supposed to be billed under one billing code. This is referred to as “unbundling.”

What Is the Penalty for Medicaid Fraud?

The penalties for Medicaid fraud in state or federal court are steep. If convicted:

  • You may be imprisoned for a minimum of five years and as much as 99 years, depending on the amount of money involved in the offense.
  • Your assets may be forfeited to the government.
  • You may be ordered to pay restitution.
  • Fines may be imposed of hundreds of thousands of dollars.

In all cases, whether you are convicted of a misdemeanor or felony for Medicaid fraud, or have civil penalties imposed, you will be suspended from participation in the Medicaid program for a minimum of five years and may be excluded forever.

Defenses to Medicaid Fraud

You should not speak to a Medicaid fraud investigator without your attorney present. You have the right to remain silent and anything you say will be used against you. Your answers to questions are often manipulated and twisted. Defenses you may have include:

  • You did not knowingly act with a fraudulent intent.
  • The billing problems were clerical errors made inadvertently.
  • There is insufficient evidence of Medicaid fraud.

You may think that you do not need an attorney since you did not do anything wrong. That thought can end up with you being convicted of a crime for which you have a defense.

Contact Attorney Michael J. Wynne

Whether you are under investigation or have been charged in state or federal court with Medicaid fraud, choosing a defense attorney is likely the most important decision you can make for your future. You need Michael J. Wynne on your side. Attorney Wynne is a Harvard Law School graduate who specializes in white collar criminal defense, including health care and Medicaid fraud. His experience working as a state and federal prosecutor gives him an advantage in knowing what to expect from the other side.

Mr. Wynne offers a free 30-minute case evaluation. Contact him as soon as possible at (713) 487-7975 so together you can begin preparing your defense.

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