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Medicaid and Medicare Fraud Defense Attorneys in Bowling Green, Kentucky

Bowling Green Medicaid and Medicare Fraud According to the U.S. Department of Justice (DOJ) and its Healthcare Fraud Unit, healthcare fraud occurs when a company, person, or group misrepresents something about the nature, scope, or type of medical care provided in a way that may cause unauthorized payments.

This type of fraud may be committed in multiple ways by both healthcare providers and consumers.

Because both of the Commonwealth of Kentucky and the federal government’s involvement in administering Medicaid and Medicare benefits, crimes involving healthcare fraud related to these programs may be punishable at both the state and federal levels. That is why our law firm is here.

Our Warren County criminal defense lawyer, John Caudill, is the only former Federal Prosecutor in Western and South-Central Kentucky.

From 1989 to 2005, he served as an Assistant U.S. Attorney in Louisville, Kentucky where he litigated over 50 trials to a jury verdict. From that experience, he developed an understanding of various areas of federal civil and criminal law, including Medicare and Medicaid fraud, and other white-collar healthcare fraud crimes.

Over the past 30 years, John has prosecuted and defended hundreds of people and companies during both complex state and federal criminal cases that required a precise legal strategy — from preparation to trial — to pursue and secure real results for our clients.

Whether you are a healthcare provider or consumer, you have the right to consult with an experienced Medicaid/Medicare fraud defense lawyer in Kentucky before answering any questions. You also have the right to bring an attorney with you to any interviews or meetings with a Medicaid or Medicare fraud investigator.

Because of the serious nature of healthcare fraud allegations, our skilled criminal defense lawyer in Bowling Green and Owensboro strongly recommends you do both, so your rights are protected from the start. Contact us today to get started on a unique defense strategy, so you can face your charges with confidence.

Who Investigates Medicaid and Medicare Fraud in Kentucky?

In Kentucky, The Office of Medicaid Fraud and Abuse has state and federal authority to bring both criminal and civil actions against healthcare providers — defined as any individual, corporation, or another entity, and their officers and employees, paid by Medicaid/Medicare for providing a healthcare service — and consumers who have allegedly abused the system.

It is important for both healthcare providers and consumers to understand that by the time they have been contacted, either through the receipt of an official letter or in-person contact from an investigator, the state and federal government has already gathered the evidence they need to believe the accused has engaged in fraudulent behavior.

You have the right to discuss your investigation with an attorney before responding to a request for information from law enforcement or Medicaid fraud investigators. Anything you say at this point can and will be used against you.

We can help you understand the depth of the investigation, and protect your rights from the start, so you do not say or do anything that will incriminate you or jeopardize your practice.

Contact our Kentucky Medicaid and Medicare fraud defense attorney today to ensure your rights are protected going forward.

What are the Most Common Types of Medicaid and Medicare Fraud in Kentucky?

Medicaid and Medicare provider fraud cases can be pursued against healthcare providers and consumers by United States attorneys, district attorneys, federal and state law enforcement agencies, private insurance company fraud units, and auditors who are trained in the complexities of healthcare fraud investigations and litigation.

Examples of healthcare provider Medicare and Medicaid fraud may include, but are not limited to:

  • Altering medical records.
  • Billing for a noncovered service as a covered service.
  • Billing for medically unnecessary services or procedures.
  • Billing for supplies that were never provided.
  • Billing non-existent companies for services never rendered.
  • Charging for services that you did not provide.
  • Falsifying a medical diagnosis.
  • Overbilling or double billing.
  • Prescribing unnecessary medications.
  • Providing fraudulent prescriptions.
  • Receiving kickbacks for patient referrals.
  • Submitting falsified billing records.
  • Using false credentials.
  • Using unlicensed staff.

State and federal investigations and audits involving healthcare providers may result in appearing before the Office of Administrative Hearing, suspension or permanent cancellation of your license to practice by the Kentucky Board of Medical Licensure, career-ending criminal charges, or civil liabilities. The penalties for Medicare and Medicaid fraud are too great to navigate your legal journey alone. We can help.

If you receive a record request from a Medicaid or Medicare investigator as a target of an investigation, or to request your patient and administrative records for other evidentiary reasons, contact our trusted Kentucky healthcare provider fraud defense attorney today for help.

Examples of Medicare and Medicaid user fraud may include, but are not limited to:

  • Adding an ineligible dependent to their healthcare plan.
  • Falsifying information.
  • Forging prescriptions or selling prescription drugs.
  • Identity theft.
  • Loaning their insurance card or using someone else’s coverage.

If you have been charged with Medicaid or Medicare fraud as a consumer, the penalties could result in significant jail time, and be ordered to pay restitution and fines if convicted.

Our trusted Bowling Green criminal defense attorney, John Caudill, has spent over 30 years protecting the rights of individuals who are facing complex legal cases throughout the Commonwealth of Kentucky.

Let us help you pursue the best outcome, just as we have for hundreds of clients before you.

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Contact Our Experienced Medicaid and Medicare Defense Lawyer in Bowling Green, Kentucky Today

John Caudill Attorney at Law offers aggressive defense strategies and trusted legal representation to individuals throughout the Bowling Green area and surrounding communities, including Owensboro, Franklin, Scottsville, Hartford, and Morgantown. Our law firm has a stellar reputation for pressing the prosecution to prove our clients are guilty by forcing them to prepare for a trial. This means we are not swayed by potential plea bargains, or negotiations we know are not in our clients’ best interests.

If you have been arrested and charged with a Medicaid or Medicare crime in Kentucky, contact our trusted healthcare fraud defense attorney in Warren County today by calling (270) 925-0447 or contacting us online.

We are here to fight for your rights and your freedom. Let’s get started.

Frequently Asked Questions for Our Kentucky Medicaid and Medicare Fraud Defense Attorney

Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.

Yes. Here’s why: Healthcare providers have been accused of Medicare/Medicaid fraud by patients who do not understand billing codes – and want to report what they believe to be suspicious activity or exorbitant costs – and disgruntled healthcare workers who are simply trying to put their current or former employers in a difficult legal situation. No matter how the false allegations have led to an investigation, once you reach that stage, it is going to be difficult to counter the allegations on your own. Both state and federal investigators have extensive resources and can collect all types of records from your office — even closing during the investigation. You will need a skilled criminal defense attorney on your side too, so you understand your legal rights and options to defend yourself against these allegations. You do not have to take the investigator’s word for how your case unfolds. We can help protect you from the start.

The Anti-Kickback Statute and Stark Law are both healthcare compliance laws that relate to the unlawful generation of Federal healthcare program business. The difference between the two is how referrals are given (and by whom), which makes them unlawful, and how they are penalized on both criminal and civil levels.

It depends on the details of your case. That includes whether you are a consumer or healthcare provider, which law enforcement branch investigated your case, and the extent of the fraud charges. No matter where your case is prosecuted, our skilled Medicaid/Medicare fraud defense attorney has extensive experience in both state and federal courtrooms and can help protect your rights in either jurisdiction.

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