What is a Medicaid Fraud Lawyer?
A Medicaid fraud lawyer is a specialized attorney who handles cases involving fraudulent activities against Medicaid, the government-funded healthcare program. This includes false claims, deceptive billing practices like upcoding, billing for services not provided, kickbacks, or other schemes to improperly obtain funds.
These lawyers represent different parties depending on the case:
- Defense attorneys represent healthcare providers (such as doctors, dentists, clinics, hospitals, or other facilities) and sometimes beneficiaries accused of Medicaid fraud, overbilling, unnecessary services, or submitting false claims.
- Whistleblower (qui tam) attorneys represent individuals—often employees, former staff, or insiders—who report fraud by their employers or others under the False Claims Act, helping the government recover misused public funds while potentially earning a reward.
Medicaid fraud cases can involve both civil and criminal proceedings, often investigated by state Medicaid Fraud Control Units (MFCUs), the U.S. Department of Justice, or the Office of Inspector General.
Common Cases Handled
Medicaid fraud lawyers typically deal with complex regulatory violations, including:
Billing for "Phantom" Services: Charging for appointments or procedures that never occurred.
Upcoding: Billing for a more expensive procedure than the one actually performed.
Kickbacks: Illegal payments or gifts exchanged in return for patient referrals.
Unbundling: Separating a single medical procedure into multiple billing codes to increase the total payout.
Why You Need a Lawyer for Medicaid Fraud Investigations
Because Medicaid is funded by both state and federal governments, fraud investigations can trigger severe penalties, including hefty fines, prison time, and the permanent loss of a medical license. A specialized lawyer navigates the intricate "patchwork" of health care laws—such as the Stark Law and Anti-Kickback Statute—to protect their client’s rights or ensure a whistleblower is legally protected from employer retaliation. Even if the dispute seems to be civil - just a billing disagreement, criminal sanctions may be lurking "just around the corner". An experienced defense lawyer will see the criminal implications of a civil billing dispute.
Note: If you are a healthcare provider facing an audit, it is often recommended to contact a defense lawyer early to prevent a civil investigation from escalating into a criminal prosecution.
If you are facing potential Medicaid fraud charges call our expert attorneys at the Law Office of Daniel Horowitz. (925) 283-1863
