Racine, Kenosha, and Walworth Federal Criminal Lawyer
If you have been accused of Medicare or Medicaid fraud, you are in serious legal trouble. The federal authorities are heavily involved in identifying those who are defrauding these agencies and holding them accountable in federal criminal court. Medicare fraud can include billing for services that were not medically necessary, charging excessively for services or supplies or misusing codes, upcoding or unbundling codes, or billing for supplies that were not provided to the patient.
The federal False Claims Act (FCA) is the law that is applied if any person knowingly submits a false or fraudulent claim. The penalties that are imposed can include fines from $5,500 to $11,000 per claim, and up to three times the damages to the federal government that resulted from that claim. These penalties, as they are based on a per-claim basis, can add up to hundreds of thousands of dollars or more and lead to years in federal prison. Are you charged with Medicare or Medicaid fraud? It is imperative that you have legal representation from a highly skilled federal criminal defense lawyer.
The Governing Federal Statutes
Healthcare-fraud prosecutions most often rest on two federal statutes:
- 18 U.S.C. § 1347: Federal health-care fraud. Knowingly and willfully executing, or attempting to execute, a scheme to defraud any health-care benefit program. Up to 10 years in prison, or up to 20 if the conduct causes serious bodily injury.
- 42 U.S.C. § 1320a-7b: The federal Anti-Kickback Statute. Offering, paying, soliciting, or receiving any remuneration to induce referrals for services paid by a federal health-care program. Up to 10 years in prison and substantial fines.
The False Claims Act at 31 U.S.C. §§ 3729-3733 runs alongside the criminal statutes. Qui tam (whistleblower) suits brought under the FCA frequently precede a criminal indictment, which means an early, quiet defense strategy can sometimes resolve matters before they become public. Knowing and willful are not the same as careless or mistaken. Billing-code interpretation, industry practice, and the documentation behind each disputed claim are all fertile ground for defense work.
Federal Laws and Medicare or Medicaid Fraud
There are various federal statutes that can lead to criminal charges being filed in federal court for Medicare or Medicaid fraud, including the FCA as well as the Anti-Kickback Statute (AKS). It is a crime to offer, pay, solicit or receive willfully any remuneration (directly or indirectly) that rewards referrals of items or services that are paid by one of the federal healthcare programs. The penalties can include fines of up to three times the amount of the kickback, and criminal penalties can mean fines and imprisonment in a federal correctional facility.
Medicaid fraud charges can be related to accusations of patient abuse and neglect in health care facilities. Medicaid Fraud Control Units (called MFCU) are located in both Wisconsin and Illinois, and are involved in identifying those that they believe are fraudulently collecting funds for services or equipment. The Office of the Inspector General, U.S. Department of Health and Human Services is the oversight agency for these cases, and charges are usually filed after an extensive investigation from the state MCFU. These cases involve a substantial amount of documentation and other evidence, all of which could have been misinterpreted by the authorities. It could not be more important that you get a qualified attorney with extensive knowledge and experience in federal criminal defense. The outcome of your case will in large part be the result of the actions taken by your lawyer.
Our Qualifications for Defending Against Medicare or Medicaid Fraud Charges
At Cafferty & Scheidegger, S.C., you will find highly respected and accomplished federal criminal defense lawyers. We have achieved many honors and accolades, including being listed in Wisconsin Super Lawyers® from 2008 – 2020, members of our team having a 10.0 Superb rating on Avvo, and Mr. Patrick K. Cafferty rated AV Preeminent® in criminal defense by Martindale-Hubbell®, as well as being listed in Best Lawyers. You can be confident that your case will be handled by a true legal professional. Call now.
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