Medicaid And Medicare Fraud

Experienced Protection Against Medicaid And Medicare Fraud Charges

Medicaid and Medicare fraud are considered white collar crimes – motivated by financial gain and committed through deceit. People accused of white collar crimes are often surprised to learn of the serious penalties these offenses carry, including possible fines, jail time and loss of a professional license.

If you have been accused of Medicaid or Medicare fraud, it is essential to begin building an effective defense immediately. The government has extensive resources to prosecute this type of claim. Our seasoned white collar crime defense lawyers at Rogers Sevastianos & Bante LLP can help level the playing field in your favor.

How Most Allegations Of Medicaid And Medicare Fraud Arise

Billing mistakes are a major cause of Medicaid and Medicare fraud investigations in St. Louis. The administrative portion of a practice can be challenging for physicians and smaller clinics. Business administration is not a focus of a medical professional’s education.

Interaction between health care providers and Medicare and Medicaid can be incredibly complex with constantly changing forms, rules and regulations. Gaining a full understanding of what a physician can and cannot do under these government programs can be increasingly challenging. Even with a trained administrator helping to manage this aspect of a medical practice, questions can still arise.

Billing Issues That Prompt Medicaid Or Medicare Fraud Investigations

Most Medicare and Medicaid fraud investigations in St. Louis are initiated because the government has reason to believe that a business or individual is requesting fraudulent reimbursements or practicing fraudulent billing methods. Issues commonly investigated include:

Phantom billing (billing for services that were never performed)
Charge inflation
Double billing for treatment, services or equipment
Upcoding for disorders, treatment, services or equipment
Overuse of equipment or services
Accepting or providing kickbacks
Billing for services or equipment that were medically unnecessary
Certifications for medically unnecessary services or supplies
Billing for services or equipment that were never ordered

Defenses For Medicaid And Medicare Fraud

Lack Of Evidence Defense – The government has an obligation to present concrete evidence that meets the standard “beyond a reasonable doubt” to prove any criminal allegations. Our experienced trial lawyers go over the evidence the government presents with a fine-toothed comb – inspecting, evaluating, and bringing its legitimacy into question.
Lack Of Criminal Intent Defense – It is the burden of the government to prove not only that you committed a crime, but also that you had criminal intent. This may be difficult for the government to prove, as many St. Louis Medicare and Medicaid fraud investigations are launched as the result of simple, honest mistakes on the part of health care providers.