Medicaid fraud prosecution is a high priority in Louisiana
Federal and state law enforcement aggressively investigate and prosecute allegations of Medicaid.
Medicaid has been in the news lately as a potential victim of federal budget or legislative cuts. Medicaid is public health care benefit jointly administered and funded by federal and state governments. Eligible recipients are in serious need of assistance and may be disabled, low income, pregnant or elderly.
Both federal and state governments dedicate substantial assets to investigating and prosecuting medical professionals, recipients, hospitals, clinics, home health care providers, nursing homes, medical billing businesses, pharmacies and others that may have engaged in Medicaid fraud.
Medicaid fraud in Louisiana
The Louisiana Attorney General’s Office has a Medicaid Fraud Control Unit known as a MFCU that has been nationally recognized. Almost every state has its own MFCU.
According to HealthPayerIntelligence, citing 2016 federal data, Louisiana tied for 5 th place with Arizona among all MFCUs for the number of Medicaid investigations, despite Louisiana ranking somewhere in the middle for population. Louisiana’s MFCU in 2016:
- Conducted almost 500 investigations
- Indicted or charged Medicaid fraud and other related crimes 86 times
- Got 75 convictions
- Had a staff of 54
- Spent $5.7 million
In this atmosphere of aggressive Medicaid fraud investigation, innocent defendants could be caught in the wide net. It is crucial that anyone in Louisiana or anywhere who believes that he or she is being investigated for Medicaid crime should immediately retain an attorney with health care criminal defense experience. If charges have been filed, seek legal advice immediately.
Medicaid fraud and related crime
Of particular concern currently as being vulnerable to fraudulent Medicaid practices are home health and personal care service providers, a segment of care that has grown in the push to keep the elderly at home.
Medicaid and other government health programs are governed by very complex laws and regulations. Medicaid fraud may be charged as a crime under Medicaid laws specifically or sometimes under general government health care or government benefit fraud laws. Examples of the type of behavior that could result in criminal charges:
- A provider billing the government for services never provided
- A provider submitting duplicate billing
- A provider falsifying a diagnosis or providing care with no medical need
- A provider ordering unnecessary prescriptions, medical tests or lab work
- A provider billing for a different service than that which was actually provided
- A provider taking illegal kickbacks for referrals
- A group of providers or patients conspiring to commit fraud
- A provider or patient making a false statement to the government
- Anyone obstructing a health care offense investigation
- A patient claiming medical services not received
- A patient illegally selling pharmaceuticals obtained via Medicaid
- A patient using another person’s Medicaid account
- A patient forging claims or receipts
- And many more
In extreme cases, white collar crimes like racketeering or money laundering could even be charged.
Seek a vigorous defense
Medicaid claims, billing and reimbursement are extremely complicated and it is not hard to make an innocent mistake with no fraudulent intent.
An experienced lawyer will know the exceptions and rules that apply in a Medicaid fraud case and can launch a strong defense on behalf of a defendant. This is especially important to avoid fines, prison and a criminal record. For medical providers, the negative consequences can include damage to reputation, loss of licensure, and Medicaid and Medicare delisting.
The lawyers at Damico & Stockstill, Attorneys at Law, in Baton Rouge represent medical professionals and others who need Medicaid fraud defense as well as in other health care fraud and white collar charges in Louisiana, Texas and beyond.