NEW JERSEY CRIMINAL LAWYERS

avoid criminal charges medicaid fraud audit lawyers

Tips from Medicaid Fraud Audit Lawyers on How to Avoid Criminal Charges

Introduction

When accused of Medicaid fraud as a healthcare provider, it can be a daunting and overwhelming experience. It is important to know that not all accusations of fraud are valid, and there are ways you can protect yourself from being falsely convicted. If found guilty, this may lead to both criminal charges and civil penalties resulting in heavy fines, loss of medical license, and even imprisonment. Therefore, it is crucial to have knowledge of how to prevent criminal charges when facing a Medicaid fraud audit. In this article, we will discuss how you can keep yourself safe from facing criminal charges during the auditing process.

Understanding Medicaid Fraud

Medicaid serves as a joint federal and state program that provides healthcare coverage for low-income individuals and families with disabilities or the elderly. The program receives funding from both the federal government and individual states with each state having its set of regulations and policies. Healthcare providers participating in Medicaid have to comply with these regulations while submitting rightful claims necessary for reimbursement.

Medicaid fraud occurs when healthcare providers intentionally give false or misleading information to receive payment or benefits from the program illegally. This includes an act like billing for services not provided, unbundling (separating services meant to be billed together), kickbacks (accepting payments for patient referrals), upcoding (billing for higher service levels than what was offered), among others.

Steps To Prevent Conviction Of Medicaid Fraud

When going through a Medicaid fraud audit investigation or faced with lawsuit charges of fraudulent activities, there are steps you can take towards protection against criminal charges:

1. Hire Proficient Medicaid Audit Lawyers 

The very first thing you should consider doing when audited by Medicaid for fraudulent activity is hiring a skilled attorney specializing in healthcare fraud defense.  These lawyers will guide you throughout the auditing process while ensuring your protection rights during any investigations conducted. 

2. Conduct An Internal Audit 

Before the audit process starts, conduct an internal audit of your records to identify possible issues that could arise during the review. Doing so will enable you to correct any errors or mistakes before auditors detect them, minimizing or possibly eliminating any fines or penalties evaluated. 

3. Give Full Cooperation To Auditors 

While working towards personal protection during a Medicaid fraud audit investigation, it is equally important to communicate with auditors excellently. This includes submitting all requested documents and information in good time, being open-minded and transparent about your billing practices and office operations while answering auditor’s questions honestly and accurately. By doing this, auditors see that you have nothing to hide; thus, cooperativeness may work more in your favor during the investigation. 

4. Maintain Comprehensive Documentation 

Maintain adequate records of all services inclusive of medical records, referral agreements as well as billing statements that avoid even the slightest possible accusations for Medicaid fraud. Keep track of any changes made to patient files/documentation. 

5. Staff Compliance Training         .

Ensure everyone within your team from physicians even administrative staff undergoes mandatory Medicaid rules/regulations training towards keeping up full compliance.  Make sure everyone understands proper billing practices plus maintaining accurate documentation. You should provide additional training if necessary to keep personnel updated on any updates/changes occurring within Medicaid regulations.

Bottom Line

Going through a Medicaid fraud audit investigation is terrifying but taking specific steps can guarantee you’re safe from criminal charges/civil penalties.  Remember to hire skilled lawyers in healthcare fraud defense matters; conduct internal record audits, bring full cooperation towards making everything flawless between you and auditors while maintaining detailed documentation of services offered. Moreover ensure staff members receive adequate training regarding their role in compliance with rules/regulations set forth by Medicaid (refer below). ​

Table 1: Potential Penalties for Medicaid Fraud

​

 
​