Attorney Darwin Overson provides experienced legal representation to individuals facing charges for Medicare and Medicaid fraud. Many medical providers and healthcare practitioners find themselves in the midst of complicated criminal proceedings related to their Medicare and Medicaid billing, coding, and referral practices. When this happens, you need a skilled criminal defense attorney who can help you navigate through the process. If you are charged with Medicare and Medicaid fraud, you may also face a substantial number of criminal charges, steep fines, imprisonment, loss of medical license, or permanent exclusion from participating in Medicare and Medicaid programs, depending on your circumstances.
If you or someone you know has been charged with Medicare or Medicaid fraud, you should contact an attorney who will fight for your rights. The team of attorneys working at the law office of Darwin Overson have the skills and experience that can help you get through this complicated situation. Darwin has been a criminal defense practitioner for over 20 years, and he is committed to relentlessly and aggressively representing clients accused of fraud. To schedule a consultation, call our Salt Lake City Medicare and Medicaid fraud lawyer at (801) 758-2287.
Fraudulent Medicare and Medicaid Criminal Charges
There is a wide variety of situations and business management blunders that can lead to criminal charges of Medicare and Medicaid fraud. Some billing and accounting problems may appear harmless, but if left uncorrected – or if seeming to establish in a pattern – they can be construed as fraud. Medicare and Medicaid criminal charges include:
- Overbilling
- Billing dead or false patients
- Submitting a code for a service that was not covered or needed
- Submitting bills for services that are not performed
All these situations above can easily occur by mistake and not reach the level of fraud in Utah, which requires a material deception. An attorney can explain what “material deception” means at greater length and when it applies. Contact our Salt Lake City Medicaid and Medicare fraud attorney for help understanding your fraud charges.
You do not need to specifically intend to defraud in order to be charged. For example, you may receive Medicaid or Medicare benefits by mistake. Perhaps you have been reimbursed too much money or received coverage you were not entitled to due to someone else’s error. If you realize the error and do nothing to correct it, you may be charged with fraud. It does not matter that you were not the one who initiated the fraud. By knowingly accepting fraudulently obtained benefits, you are a part of the fraud scheme and may be criminally charged or held civilly liable.
The Difference Between Medicare and Medicaid Fraud
People often think of Medicare and Medicaid as going hand-in-hand. Some people may actually think they are the same thing. The government manages both programs in order to provide people with medical care. However, there is a key difference between them. Medicare is a federal program run by the federal government, but Medicaid is a state-run program. Medicare is the same for everyone across the country, but Medicaid rules and regulations might vary somewhat between states.
This difference is significant when it comes to assessing fraud charges. If you are charged with fraud relating to Medicaid, your charges will most likely be at the state level and you will be tried in Utah courts by Utah prosecutors. If you are charged with fraud relating to Medicare, your charges will be at the federal level. This means you can be tried in a federal court and you will face federal penalties. Medicaid and Medicare are so intertwined that defendants are often charged with fraud of both. Your charges may be both state and federal charges. Our Salt Lake City Medicaid and Medicare fraud lawyer is here to help you no matter what your charges are.
Federal Laws Against Medicare and Medicaid Fraud
There are multiple federal laws designed to prevent Medicare and Medicaid fraud. Anyone charged for Medicare and Medicaid fraud may face charges for violating the:
- False Claims Act, which prohibits fraud against governmental units.
- Anti-Kickback Statute, designed to prevent remuneration in exchange for referrals for services payable by a federal program.
- Stark Law or Physician Self-Referral Law, which prohibits referral of Medicare and Medicaid patients to service providers who have a personal or financial relationship with the referring physician.
- Exclusion statutes prohibiting medical referrals to individuals excluded from participating in Medicare and other health care programs.
In addition to the laws described above, anyone who is investigated for violating any of these crimes can also be subject to liability for other federal crimes, such as money laundering, conspiracy and obstruction of justice. For example, failing to preserve documents can lead to further serious complicated charges for the destruction or alteration of records in a federal investigation, and even obstruction of justice. Someone guilty of obstruction can be sentenced to up to 20 years in federal prison and fined $250,000. With the support of your attorney, you can avoid finding yourself in greater complications.
Moreover, depending on the findings of your investigation, you may be charged with multiple counts for each finding of Medicare and Medicaid fraud. If you are convicted for fraud, you may end up with a fine that is double the alleged fraud amount, plus possible imprisonment and the loss your DEA license to prescribe medications. Also, there are instances when states initiate parallel proceedings for related state law violations. With the right legal representation, you can fight these allegations and obtain a reduction or dismissal of the charges. Call our Salt Lake City Medicare and Medicaid fraud lawyer for a free legal consultation.
People Who Can Be Charged with Medicaid and Medicare Fraud in Salt Lake City
Medicare and Medicaid fraud is often committed by individuals who want to obtain money or services they are not entitled to. However, this kind of fraud can also be perpetrated by doctors and health care institutions. The means of committing the fraud might be somewhat different, but the charges and penalties are the same.
A doctor or someone who works for a hospital or healthcare facility may commit Medicare or Medicaid fraud. This fraud could be for the purpose of obtaining money or services for the hospital or healthcare facility, for a patient, or for themselves. People who work for healthcare facilities and institutions are in a unique position because they are more likely to understand the ins and outs of Medicare and Medicaid. If you work in healthcare and have been charged with Medicare or Medicaid fraud, call our Salt Lake City Medicare and Medicaid fraud defense lawyer.
Penalties for Medicare and Medicaid Fraud Under Utah’s False Claims Act
Medicare and Medicaid fraud carries both criminal and civil penalties. These penalties operate independently of each other. This means you do not need to be charged criminally for Medicare or Medicaid fraud to be held civilly liable and vice versa. Below are the potential criminal and civil penalties a person might face in Utah for Medicare or Medicaid fraud.
Criminal Penalties
In Utah, the type of Medicare and Medicaid fraud charges are determined by the cumulative value of the funds or other benefits received. Depending on the alleged dollar amount, your charges can range from the more severe felony Medicare and Medicaid fraud to a class A or class B misdemeanor. The penalties and associated charges include:
- Second-degree felony charges will be imposed for fraud of $5,000 or more. Convictions can result in a prison term of one to 15 years and a fine of up to $10,000.
- A third-degree felony may be charged for fraud totaling an amount of $1,500 or more, but less than $5,000. A conviction can lead to up to five years in prison and a fine of up to $5,000.
- A class A misdemeanor may be charged for fraud of $500 or more, but less than $1,500. A conviction may be punished with a prison term of no more than 364 days.
- A class B misdemeanor may be charged for fraud of an amount less than $500. A conviction may be punished with a prison term of no more than 6 months.
Fraud charges are not based on the number of instances of fraud. Instead, the total value of your ill-gotten gains is what determines your charges. For example, if a person committed ten smaller acts of Medicare or Medicaid fraud that totaled $10,000, and another person committed one larger act of Medicare or Medicaid fraud for $10,000, their charges would be very similar if not exactly the same. If you need help understanding the charges against you, contact our Medicare and Medicaid fraud defense attorney as soon as possible.
Civil Penalties
Civil penalties for Medicare or Medicaid fraud will mostly be monetary in nature. A person held civilly liable for fraud will have to pay very heft fines to the state. If you are held civilly liable for Medicaid or Medicare fraud, you will have to pay back all the money you obtained through fraud. You will also have to cover the expenses of the state for investigating and enforcing anti-fraud laws. This can include costs of lawyers, investigators, and any other public officials or employees that were involved. Finally, the court may enforce a civil penalty fee of no more than triple the amount of your total fraud, which is to be paid to the state.
While a criminal action does not have to occur in order to be held civilly liable, it is possible that the above civil penalties could be imposed as part of a criminal judgment.
Recovery Auditor Contractor (RAC) and Fraud Audit Programs
Many physicians and medical service providers find themselves facing Medicare and Medicaid fraud charges as a result of audits. There are Medicare audits known as Recovery Audits Programs that have a look-back period of three years concerning billing and coding practices. These audits have become more prevalent these days to correct:
- Incorrect payment amounts
- Non-covered services
- Incorrectly coded services
- Duplicate services
RACs affect most healthcare providers, and there are instances when physicians have found themselves dealing with a host of complications due to failing these audits. You can be charged with obstructing a Medicare or Medicaid audit if you fail to respond promptly and adequately to an audit request. Your attorney can help you understand this process at greater length. Contact our Salt Lake City Medicaid and Medicare fraud lawyer for help.
Call Our Salt Lake City Attorney for Criminal Defense Against Medicare and Medicaid Fraud
For anyone charged with Medicare and Medicaid fraud in Utah, the state must establish that he or she engaged in the criminal activity “knowingly, intentionally, or recklessly.” In a nutshell, all three of these types of conduct is essentially more than a mere error. Your attorney can help you understand what this means and what types of conduct typically meet the legal requirements warranting a potential criminal conviction.
Whether you are the subject of a fraud investigation or an audit, you should consider retaining an experienced attorney who can help you secure your legal rights through these procedures. Call Overson & Bugden, at (801) 758-2287 to schedule a free and confidential consultation.
