The team of attorneys of Young, Marr, and Associates will defend you if you are facing charges of Medicare or Medicaid fraud in Pennsylvania. Any healthcare professional can be accused of Medicare or Medicaid fraud, including doctors, nurses, therapists, clinic owners, and other employees.
Most fraud charges stem from investigations that should be approached with caution. Pennsylvania’s growing reliance on Federal Health Care programs such as Medicare and Medicaid has led to significant initiatives putting health care professionals under scrutiny. Programs such as the Recovery Auditor Contractor Programs (RAC) have become a serious source of legal complications for hardworking healthcare providers. Your freedom, your reputation, and your livelihood are at risk. Depending on your situation, you can face prison time, steep fines, the loss of your DEA license, permanent exclusions from Medicare and Medicaid programs, and other serious consequences. This type of accusation can be frightening, and you will need a bold and experienced criminal defense attorney who will tear apart all the inconsistencies and unconstitutional aspects of the accusation and investigation.
If you or someone you know have been accused of Medicare or Medicaid fraud, don’t put your future at risk with poor legal representation. The team of attorneys of Young, Marr, and Associates will provide skilled and aggressive legal representation to help you fight the charges. To schedule a consultation, contact us at (215) 372-8667.
Pennsylvania Medicaid Recovery Audit Contractor (RAC)
Pursuant to 42 U.S.C. § 1396a(a)(42), Pennsylvania has instituted a program for the review and investigation of claims submitted by healthcare service providers. Based on these audits, referrals regarding suspicion of fraud or abuse are submitted to the Pennsylvania Office of the Attorney General. What most medical providers are finding is that these audits can quickly turn into overzealous and antagonistic investigations. Any medical provider facing this type of situation can benefit from proper legal representation to avoid unnecessary and costly legal ramifications.
Overview of Medicare and Medicaid Fraud in Pennsylvania
Various federal and state statutes address Medicare and Medicaid fraud. Medicare and Medicaid charges are hardly the only accusations defendants face in Pennsylvania. Other criminal charges frequently include:
- Theft by deception
- Tampering with public records for billing practices, such as billing services that were not provided or inflating the number of hours of service provided
There are significant penalties for any of the charges listed above. If you are convicted of Medicare or Medicaid fraud or related crimes, you can lose your freedom and your means of financial support. In both Pennsylvania and the federal system, judges have a great deal of discretion in the application of sentencing guidelines. However, when there are multiple charges in Pennsylvania, each offense is assigned a gravity score that will impact the ultimate level of penalties imposed if convicted. Depending on the accusations you are facing, a qualified attorney can explain at greater length all the possible penalties as well as other options available.
With the right legal representation, your constitutional rights are protected through this process because there are protections in these investigations that most people are not aware they have. Proper subpoenas and warrants must be provided. These legal documents can be very confusing, especially when related to hundreds of medical billing documents that can date back as far as three years. You need a seasoned criminal defense attorney at your side to address illegal actions and fight to protect your legal rights.
Medicare and Medicaid Fraud Statutes
There is a substantial body of laws that can lead to any number of surprising results of audits and federal investigations. With the right legal representation, you can safeguard your rights while at the same time be prepared to defend yourself against the criminal charges brought against you.
While these investigations can be intimidating, an attorney can explain your likelihood of facing prison or an acquittal. Medicare and Medicaid fraud statutes require a high standard of proof. An attorney can explain in detail what types of proof are needed to show actions were made “knowingly,” as opposed to by mistake, in order to be convicted of the following crimes:
False Claims Act in Pennsylvania
Pennsylvania has adopted these anti-fraud statutes. This law allows the government as well as employees of healthcare facilities to file a lawsuit or recover damages and penalties for submitting allegedly false claims or retaining an overpayment of such funds for more than 60 days. The fines include a penalty of up to three times the criminal proceeds and civil penalties ranging from $10,957 to $21,916 for each false claim, plus the costs of the civil action.
Federal False Statements Act
The False Statements Act prohibits making false or fraudulent statements, false writings or documents, or the concealment of what is known as a “material fact.” A material fact is typically something that will have an impact or will be considered significant in the case. The false or misleading statements can be made during the course of an investigation or to any healthcare provider.
Health Care Fraud
Anyone who is found guilty of healthcare fraud can face fines and up to 10 years in prison. Charges under this statute stem from accusations of engaging in a scheme to defraud healthcare benefit programs.
Call a Pennsylvania Medicare and Medicaid Fraud Lawyer You Can Rely On
The attorneys at Young, Marr, and Associates are committed to representing doctors, nurses, clinic owners, and other healthcare professionals through this challenging time. To discuss the details of your Medicare or Medicaid fraud defense, or if you are under investigation, contact us at (215) 372-8667.