Denver Medicaid Fraud Lawyer

Medicare Fraud Defense for Colorado Residents

Medicare and Medicaid fraud is a very serious issue both on a statewide and federal level. Both forms of fraud are considered white collar crimes and charges may be lodged against consumers or providers of services. Medicare fraud was determined to cost taxpayers approximately $60 billion or about 10 percent of the annual budgeted amount while Medicaid fraud is estimated to cost about $14.4 billion or nearly five percent of the budgeted amount.

Since the Affordable Care Act was enacted and government healthcare coverage costs increased, a large increase in healthcare fraud has occurred. If you are facing charges for government medical insurance fraud, call a Medicare or Medicaid fraud defense attorney in Denver right away.

Who Can Face Medicaid & Medicare Fraud Charges?

As previously stated, both beneficiaries and providers can face charges of insurance fraud. Whether you are a medical care provider such as a physician, nurse, or medical billing employee; or you are a patient charged with fraud, you need to hire a Denver Medicaid fraud lawyer immediately.

Some of the common reasons a provider can face charges are:

  • Overbilling of services – providers who have not performed services and have billed for them could face charges of fraud. These charges are very serious as they could ultimately result in the provider being banned from receiving any type of payment from these programs. False diagnosis is also another common way providers have defrauded Medicaid and Medicare.
  • Violation of Stark and Anti-Kickback Laws – providers are strictly prohibited from referring patients to other providers in return for any type of financial gain. This includes referrals for any type of services including laboratory work, physical therapy, second opinions, etc. All types of providers and medical billing companies are bound by these rules.
  • Up Billing patients – when a hospital, physician’s office or a billing company improperly codes procedures or they bill services individually when they are offered as a “bundle”. All submissions for reimbursement must be properly coded and if a pattern of abuse is discovered the provider could face fraud charges.

Beneficiaries of Medicare or Medicaid are not exempt from charges of fraud. Some of the ways beneficiaries can defraud the system include:

  • Falsifying application information – understating income, overstating household size and hiding assets have all been ways that beneficiaries have qualified for assistance under these programs. Should they be discovered, they may be barred from receiving these benefits as well as other federal or state benefits.
  • Improper use of medical insurance – beneficiaries have been found guilty of allowing a non-eligible person to use their insurance card for the purposes of obtaining services. Doing so violates the law and also will result in the eligible beneficiary losing their coverage.
  • Tampering with receipts and bills – beneficiaries who tamper with properly issued bills or receipts in order to increase the amount they may be entitled to be reimbursed are violating both state and federal laws and will face harsh penalties including the loss of coverage.

Penalties for Consumer Medicaid & Medicare Fraud

Insurance fraud laws in Colorado have been strengthened due to numerous legislative changes. While providers may face state or federal charges, in nearly all cases, Colorado counties handle the prosecution of insurance fraud by consumers.

On a county and state level, beneficiaries could face up to one year in jail, be required to pay steep fines and be prohibited from participating in these programs permanently. Depending on the amount of benefits obtained fraudulently, you could be facing Class 5 felony charges and face serious jail time and probation for as long as 12 years. In addition, you will have to deal with having a life-long felony record.

Medicare & Medicaid Provider Fraud Penalties

Provider fraud is handled far more harshly; providers will no longer be able to get any reimbursements from either program if they are found guilty. Generally, the charges are investigated and enforced by the US Department of Justice, the Department of Health and Human Services and the Office of the Inspector General. In addition to losing the right to bill any further services to these programs, the person who is convicted of fraud will also face a minimum of five years in federal prison, and fines ranging from $250,000 to more than $1 million.

If you are a provider charged with fraud, call our Medicaid and Medicare fraud lawyers right away so that we can start building your defense. It is crucial to your case that you do not incriminate yourself by speaking with investigators without an attorney.

Contact Denver Medicaid & Medicare Insurance Fraud Attorney Kevin Cahill

Since Medicare and Medicaid fraud is normally only charged after an extensive investigation, you will probably learn about your charge long before an indictment can be filed against you.

If you find you are under investigation for any insurance-related fraud charges, contact the Law Office of Kevin Cahill at (720) 548-2990 immediately. You need a Denver Medicaid fraud lawyer on your side asap if you are under investigation. The sooner we get involved, the better the chances are that we can prevent an indictment or when we are unable to stop the indictment, can better prepare your defense.

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