Medicaid Fraud Lawyer in Columbus, OH
Whether you are a health care provider, medical facility employee, or a benefits recipient, a Medicaid fraud charge is a serious matter. Many people find themselves in this situation, and some may be unsure how it happened or what it means. However, it is a crime in Ohio to commit healthcare fraud, and the consequences of this white-collar crime are real.
If you are a medical professional, an Ohio Medicaid fraud conviction could mean losing your license, closing your practice, and falling out with patients who trust you. If you are a healthcare facility, it could mean years of stringent audits and constant monitoring from authorities who have you on their radar. If you are a consumer, you may find it difficult to find or keep a job or pursue other opportunities once people see your conviction as a red flag.
Medicaid, a health insurance program jointly run and paid for by state and federal governments, provides medical care to millions of people in the United States with limited income and resources. Medicaid fraud is any illegal practice that misuses money for these recipients.
Fraudulent Medicaid practices can mean various things. A medical practitioner who bills for services they did not provide can be charged with this offense, but so can someone who allowed their healthcare provider to bill them for services they never received. Still, sometimes, people charged with Medicaid fraud may have made a simple billing error or not know someone stole and used their identity for fraudulent activities. All the people in these situations could seek a defense attorney’s help.
If you are charged and ultimately convicted of committing Medicaid fraud in Columbus Ohio, you can end up facing numerous criminal penalties, all of which are extremely serious. In addition to spending time in a federal detention center, you might be looking at costly fines and other penalties if you are ultimately convicted in your criminal case.
Medicaid Fraud Defense Lawyers Helping Health Care Providers Facing Criminal Charges
No matter who we help or what charges they face, we offer straightforward counsel from the start about what they are up against. If you find yourself facing charges of Medicaid fraud near Columbus, you should seek out legal representation as soon as you learn of the charge. We can help you even if you’ve just learned about a healthcare fraud investigation that turned up your name or led investigators to come to talk to you.
You don’t have to talk to anyone without legal representation present. Our Columbus healthcare attorneys can protect your rights throughout the entire process and prepare one or more legal defenses to advance your case.
Joslyn Law Firm is widely recognized and respected in Ohio and nationally for its work ethic, professionalism, and commitment to giving effective legal representation to its clients. We are proud of our honors and accomplishments, which show how serious we are in helping people in Columbus and throughout Ohio. They include:
- Top American Lawyers
- Top 100 Trial Lawyers by the National Trial Lawyers
- Rising Stars 2022 by Super Lawyers
- Columbus CEO Top Lawyer
- Top Attorney for Criminal Defense by Avvo Clients’ Choice Superb
- Best Criminal Defense Attorneys in Columbus – Expertise, 2022
Let the Columbus Ohio Medicaid fraud attorneys at Joslyn Law Firm assist you with a defense in your criminal case today. Please call us at (614) 444-1900 or contact us online to learn more about how we could assist with defending you against your pending criminal charge.
Medicaid Fraud in Columbus, OH, Information Center
- Medicaid Fraud Overview: What Is a Charge for Medicaid Fraud?
- What Penalties Can I Face if I’m Convicted of Medicaid Fraud?
- How Our Medicaid Fraud Defense Lawyers Near You Can Help
- Defenses in Ohio Medicaid Fraud Cases
- Evidence in Ohio Medicaid Fraud Cases
- Medicaid Fraud Resources
- Notable Ohio Medicaid Fraud Cases
- Ohio Medicaid Fraud News
- Ohio Medicaid Fraud FAQs
- Speak With a Columbus Medicaid Fraud Attorney Today
Medicaid fraud happens when someone intentionally provides false or deceptive information to get the Medicaid program to pay for medical services or care. There are several ways in which a person may commit Medicaid fraud. Some common ways that Medicaid fraud is committed include the following:
- An individual engages in altering, falsifying, or destroying one or more documents that are necessary for obtaining Medicaid reimbursement after he or she has already billed Medicaid
- An individual knowingly or intentionally makes a misleading or false statement (or causes such a false or misleading statement to be made), in order for that individual to obtain some form of Medicaid reimbursement
- An individual knowingly accepts or solicits a payment in exchange for certain Medicaid services, with the specific purpose or intention of committing Medicaid fraud
Some activities that may constitute Medicaid fraud include:
- Issuing one or more false invoices for payment
- Billing for medical services that were never actually provided to a patient
- Billing for unbundled services
- Overly utilizing certain medical services or procedures
- Billing for medical equipment that was never ultimately provided
If you have been accused or formally charged with committing an act of Medicaid fraud, it is important to have a Columbus Medicaid fraud lawyer on your side as soon as possible, so that he or she can immediately set to work on defending against your criminal charge. Our healthcare fraud attorneys in Ohio have helped people just like you.
If you are charged with and convicted of Medicaid fraud, you naturally wonder if you will go to jail. The penalties for a guilty plea or conviction will vary depending on which court convicts you and how much the fraud was worth. The following are some possible penalties for Medicaid fraud in Ohio:
- If the fraud is worth $1,000 to $7,500 = Fifth-degree felony charges and up to 12 months in jail
- If the fraud is worth $7,500 to $150,000 = Fourth-degree felony charges and up to 18 months in prison
- If the fraud is worth more than $150,000 = Third-degree felony charges and up to five years in prison
Some additional consequences that you could be facing for Medicaid fraud include the following:
- Being expelled from the Medicare or Medicaid Program
- Losing staff privileges
- Having your medical license either suspended or revoked
- Imposition of fines and/or costs
If you or your medical practice has been accused of committing Medicaid fraud near Columbus, you want an experienced Medicaid fraud attorney in your corner, assisting you with your legal defense as soon as possible. These cases are highly complex, so having a legal professional working on your case can ensure you receive guidance from someone who knows what they are doing.
Our Columbus Medicaid fraud lawyers will do everything in our power to keep criminal charges from being filed against you if you are under investigation by the Medicaid Fraud Control Unit (MFCU) or facing civil penalties. If criminal charges are ultimately filed in your case, an experienced attorney can present all possible defenses, as well as request a charge reduction or ask the federal judge overseeing the case to impose the lightest possible penalty under the circumstances.
A Medicaid fraud attorney may also be able to represent you before a state licensing authority to fight against your professional license being suspended or revoked, depending on the circumstances.
One of the strongest legal defenses that an attorney could make on your behalf is that you did not have the specific intent to defraud. In some instances, mistakes are made by office staff and other individuals, resulting in a false Medicaid fraud charge.
While medical offices should have the necessary and proper systems in place to prevent billing mistakes and other errors from occurring, an honest mistake made by a provider, or a member of the provider’s staff should not result in criminal charges being imposed against the provider.
Other ways our Ohio Medicaid fraud lawyer can help your case include:
- Explaining the state and federal laws that apply to your case, such as the False Claims Act
- Representing you in all meetings and legal proceedings
- Managing all communications with case parties
- Advising you on the possible outcomes of your case
- Representing you at trial if necessary
For you to be convicted of committing Medicaid fraud, the government prosecutor has the burden of proving that you committed the crime beyond a reasonable doubt. This legal standard is high, and if the government is unable to prove even one legal element of the alleged crime, your case may wind up being dismissed.
One of the hardest legal elements of Medicaid fraud for the government to prove is that you knowingly intended to defraud the United States government. Moreover, there are several legal defenses that you might be able to argue in response to a Medicaid fraud charge that is lodged against you.
A Medicaid fraud law firm like Joslyn Law Firm can review the circumstances of your charge and work with you to formulate the best possible legal defense on your behalf. We challenge the prosecutor’s case against you in any possible way to protect your rights.
Medicaid Defenses Cover Various Circumstances
In these cases, they must show defendants knew and intended to create a scheme to defraud a healthcare program and that they executed the plan to commit insurance fraud. We will personalize your defense according to the circumstances of your case. However, your defense strategy could involve any of these common defenses that are used often in white-collar crime cases:
- Lack of intent or mistake: Prosecutors must prove there was willful intent to commit Medicaid fraud. If we can show you acted in good faith and accidentally made a billing error or another mistake involving a Medicaid transaction, you can challenge the assertion that you intentionally tried to commit fraud.
- Illegal search and seizure: We can challenge your arrest, investigation, and evidence if we discover a violation of your Fourth Amendment rights, which protect you against an illegal search and seizure process. We can also challenge the evidence if it was obtained illegally.
- Not enough evidence: If the government agency cannot show intent to defraud in your case, you cannot be convicted of Medicaid insurance fraud.
- Mistaken identity: If someone erroneously names you as a participant or initiator of Medicaid fraud, you can challenge those accusations.
- Consent: If you received permission to perform or bill for services and you were authorized by a person or entity that could consent, you can defend yourself against healthcare insurance fraud allegations.
- Voluntary disclosure: If you self-reported a Medicaid violation via a voluntary disclosure process, you could challenge Medicare claims against you.
- Entrapment. You can challenge insurance fraud allegations if you can show an undercover law enforcement officer influenced you to do it.
These are just a handful of defenses we could use. Our Columbus Medicaid fraud attorney will examine all aspects of your case. We can talk with you and ask questions to ensure we understand your position as we advocate for a favorable outcome and fight for your future.
In addition to developing your defense against Medicaid fraud allegations, it is our responsibility to find holes and inconsistencies in the opposing side’s claims. This can help our attorney as we seek to minimize any penalties you may face.
The evidence you have to prove your case will weigh heavily on its outcome. If you are under investigation for Medicaid fraud in Ohio, we encourage you to preserve evidence that can help us tell your side of the story and clear your name. This evidence can include:
- Financial documents regarding Medicaid services that show the services performed, the medical professional who performed them, when they were received, and how much was charged for them
- Witness testimony that clears your name and how you handled Medicaid claims and billing transactions
- Electronic communications showing the time stamps of when transactions occurred (emails, cellphone or landline phone records, text messages)
- Correspondence that shows you reported Medicaid fraud to authorities (For example, you can show that you acted promptly when you found out that a patient was a victim of medical identity theft.)
- Documentation from authorities showing your Medicaid claim audits were cleared and that you followed state and federal laws.
- Any documentation/proof that shows you were forced or led to commit Medicaid fraud, such as if you were threatened or given alcohol or drugs without your consent and then did illegal transactions while under the influence or intoxicated.
Insurance fraud cases vary in complexity, so the evidence we can collect in your case will be unique to your situation.
What’s the Difference Between Medicare and Medicaid? – Some may use Medicare and Medicaid interchangeably, but they are not the same programs. One key difference between them is that Medicare is a federal health insurance for people aged 65 and older, while Medicaid is a joint federal and state that covers healthcare costs for eligible people who have limited income and resources, regardless of their age. This U.S. Department of Health and Human Services (HHS) resource explains other ways they are different and what each program does.
Medicaid Provider Fraud Cases in Ohio – This case roundup from the Ohio Attorney General’s office features defendants in Ohio who were convicted on various Medicaid fraud offenses. The summaries generally explain the charges and the outcome of each person’s case. Offenders received varying prison sentences, and some were ordered to pay restitution for their crimes in addition to serving time.
There Are Many Types of Medicaid Fraud – This resource from the Centers for Medicare and Medicaid Services (CMS) highlights common types of Medicaid fraud and gives examples of each.
CMS Medicaid Program Integrity Strategy – This CMS resource explains various CMS initiatives to “create greater transparency in an accountability for Medicaid program integrity performance, enable increased data sharing and robust analytic tools, and seek to reduce Medicaid improper payments across states.” The initiatives include conducting audits of state beneficiary eligibility determinations in states that have received an Office of Inspector General (OIG) review and providing education to Medicaid providers to reduce billing errors.
Upcoding Medicare: Is Healthcare Fraud and Abuse Increasing? – Although Medicare and Medicaid are different, upcoding is a common fraudulent practice that affects both programs. This analysis published in Perspectives in Health Information Management looks at upcoding, an illegal billing practice that inflates Medicare claims so that providers can receive higher reimbursements, and how it affects Medicare payments and fraud. It concludes that upcoding claims has increased payments from Medicare and that the practice occurred too often, suggesting that CMS fraud and abuse have taken place. It also encourages increased training to reduce upcoding occurrences.
Report Medicaid Fraud – Anyone can submit a report of Medicaid fraud through the Ohio Attorney General’s website. Anyone making a report must include their name, specific details about the case, as well as the name of the provider or person committing the fraud. The form has space to include additional supporting documents, the provider’s address, the date of occurrence, and other items.
The following are cases in Ohio involving Medicaid insurance fraud:
Two Central Ohio Caretakers Sentenced for Felonies – Ohio Attorney General Dave Yost announced via a February 2023 news release that two criminal cases his office investigated have been resolved. One case, investigated by the Medicaid Fraud Control Unit of Yost’s Health Care Fraud Section, involves Jackie Little of Columbus who pleaded guilty in Franklin County Common Pleas Court to one count of theft, a second-degree felony, and one count of theft from a person of a protected class, a third-degree felony. Little worked at the Laurels of Hilliard, where she took more than $1 million from residents’ funds and insurance payments. She must pay back the victims $1.14 million and serve four years in prison. The prison sentence will be suspended after five years of probation and other treatment measures, the news release says.
The other case involves Aminata Fofana, a former nurse at a nursing and rehabilitation center, who pleaded guilty to one count of involuntary manslaughter, a third-degree felony, in the death of a male patient who passed away after Fofana failed to reconnect his oxygen after cleaning his tracheotomy tube. The Medicaid Fraud Control Unit assisted the Delaware County Sheriff’s Office with the case.
State v. Bamonte, 2022-Ohio-1331 – A jury returned a guilty verdict for defendant-appellant Anthony Bamonte, who was charged with grand theft and Medicaid fraud in the Franklin County Court of Common Pleas in 2018. Bamonte appealed his case, challenging the state’s evidence and the weight of it. After reviewing Bamonte’s appeal in 2022, the Court of Appeals of Ohio Tenth Appellate District found that the state’s evidence was legally sufficient to convict Bamonte for both offenses. From the Court’s opinion:
“The state presented legally sufficient evidence for a reasonable jury to find that Mr. Bamonte purposely deprived ODM of funds in excess of the $7,500.00 threshold for grand theft, and that he used deception to accomplish this purpose.” State v. Bamonte, No. 19AP-875, 18 (Ohio Ct. App. 2022)
Also, “The state’s evidence also demonstrated that Mr. Bamonte deceived ODM by filing claims on behalf of Medicaid recipients who never received the medical supplies billed for or had no knowledge that his company had billed for supplies on their behalf. Nine different Medicaid recipients testified at trial that they had never ordered DME or had knowledge of Mr. Bamonte’s company.” State v. Bamonte, No. 19AP-875, 18-19 (Ohio Ct. App. 2022)
Nine Charged in Scheme to Defraud Medicaid – In November 2020, a Cleveland federal grand jury indicted nine people for their role in a Medicaid fraud scheme involving the Eye for Change Youth & Family Services, Inc., an Ohio nonprofit, according to this news release from the United States Attorney’s Office, Northern District of Ohio. The people owned, operated, or worked for the organization. The jury returned a 28-count indictment for those named in the scheme, which took place between February 2017 and September 2020. According to the indictment, during this period, defendants would bill Medicaid for services that were not performed and falsified records, among other actions.
In May 2021, Acting U.S. Bridget M. Brennan announced in a news release that 11 more people were indicted in the scheme. “The Defendants are charged with various counts of conspiracy to commit health care fraud, health care fraud, making a false statement relating to health care matters, conspiracy to commit money laundering and money laundering,” the news release says.
A report Ohio Auditor Keith Faber released in December 2022 asserts that the state could be paying ineligible Medicaid beneficiaries between $5.3 million and $24 million every year because the Ohio Department of Medicaid hasn’t been monitoring county caseworkers to ensure they disenroll people receiving benefits in multiple states. According to Cleveland.com’s article about the report, nearly 60% of duplicate payment alerts from the Public Assistance Reporting Information System went unaddressed. “We have an alert system for a reason – to ensure public benefits are being issued properly, to the people who need them,” Cleveland.com quoted Faber saying in a statement. “They’re supposed to get your attention, not be ignored, especially when millions of public dollars are potentially being misspent.”
January 4, 2022
Company Accused of Overbilling Ohio Medicaid Reaches DOJ Settlement
Dayton, Ohio-based Academy Health Care Services reached a $500,000 settlement deal with the U.S. Department of Justice (DOJ) in a case involving the False Claims Act, reports Spectrum News 1. Per the news report, DOJ said the health company, which agreed to close no later than June 30, 2022, routinely billed Ohio Medicaid for reimbursement payments that exceeded the value of the services it provided. They also charged for individual medical services when those same services were provided in a group environment. “Further, Academy nurses did not spend the time required with patients to receive reimbursement for individual services.”
February 2, 2023
Ohio Auditor Backs Anti-Corruption Training, Quick Reporting
Ohio Auditor Keith Faber recently called for more training that can help public employees detect government fraud and corruption and report suspicious activity faster, the Associated Press reports. At press time, his office was handling 700 tips and more than 100 cases, which he told a news conference is “only scratching the tip of the iceberg.” AP notes that Faber’s call for more training came amid his office marking its 100th conviction for fraud and corruption since he started his term in 2019.
Q: What Constitutes Medicaid Fraud?
A: Medicaid fraud can happen in many ways, depending on the providers involved. Generally, it commonly occurs when providers:
- Bill for unnecessary medical services or items
- Bill for services or items that a patient did not receive
- Bill for procedures under multiple codes when one global billing code covers the procedures
- Bill for a medical service or procedure for a more severe condition that was not performed to receive higher reimbursements (known as upcoding)
- Schedule more patient return visits than necessary
Medicaid fraud can also involve sharing Medicaid member ID cards, working with others to file false reimbursement claims, changing prescriptions, or writing unnecessary prescriptions, and using or selling prescription medications. Providers and patients who participate in kickback schemes involving asking, offering, or seeking beneficiary referrals or medical services or items can also face Medicaid fraud charges.
Q: Are There Ways to Tell I Am Under Investigation for Medicaid Fraud?
A: Yes, there are signs that indicate you could be part of a Medicaid or healthcare fraud investigation. Each case is different, but generally, if you notice any of these signs, you should consult a criminal defense attorney as soon as possible to protect your rights and plan your next steps:
- Authorities issue you or your practice a search warrant for medical records in your care.
- You receive correspondence from a federal or state investigator that investigates Medicaid fraud. Correspondence could even notify you that you are a target of an investigation. (This information could come from the Office of the Inspector General (OIG), the Federal Bureau of Investigation (FBI), or any Ohio agency, such as the Ohio Attorney General’s Medicaid Fraud Control Unit.)
- You receive a demand letter in a case involving the Medicare False Claims Act.
- The people you work with on Medicaid claims have been arrested or charged with fraud schemes.
- You receive more audit requests from Medicaid or health insurance companies.
- You hear from a patient, employee, or former employee that an investigator contacted them to discuss fraud.
Medicaid fraud is a serious offense in Ohio, and prosecutors can pursue the harshest consequences for those convicted on healthcare fraud charges. Luckily, you can hire an attorney at any time to guide you.
Q: If a Medicaid Fraud Investigator Contacts Me, Should I Talk to Them?
A: If a Medicaid fraud investigator from any agency reaches out to talk with you, you should secure legal counsel as soon as possible. It doesn’t matter if you are the target of an investigation or a witness; you deserve to protect your rights and interests and not say anything that could be used against you. You can hire an attorney to handle a healthcare fraud case at any time. You don’t have to wait for an attorney to file official charges in Franklin County. Investigators can pop unexpectedly, which often catches people off guard. An attorney with Joslyn Law Firm can help you navigate this situation if it happens to you.
Q: I Am a Medicaid Provider – What Should I Do If I Am a Victim of Identity Theft?
A: Medical providers can have their identities stolen by those illegally billing Medicaid for unnecessary or non-existent services, tests, doctor’s or hospital visits, equipment, and more. If you are a medical provider who suspects this has happened to you, you must report this right away. Otherwise, you could be responsible for overpayments for claims or find yourself defending yourself against Medicaid fraud allegations. You can also consult an attorney about your situation.
Q: How Can a Medicaid Fraud Attorney Help Me?
A: Healthcare fraud charges are serious, and much is at stake for defendants who face these charges. Prosecutors in Medicaid fraud cases must prove beyond a reasonable doubt to a jury that insurance fraud took place, and if they are talking to you about the crime, it is likely that is what they are going to set out to do.
Fortunately, you can hire legal counsel. An attorney with experience in Medicaid fraud cases understands the complexities of these cases and how to defend their clients against state and federal allegations. Hiring a legal professional to handle your case is a smart move for you and your family. With so much on the line, you shouldn’t risk handling the case yourself or choosing an attorney who does not understand healthcare fraud cases.
From the time your lawyer accepts your case, they will investigate the prosecution’s claims and how the incident happened, review the evidence against you, and gather evidence that tells your side of the story. They will protect your rights, advise you on the steps you should take, represent you in all hearings, and work on your behalf to achieve the best possible outcome for your situation.
Medicaid fraud can result in the imposition of both civil and criminal penalties, not to mention potential license suspension or revocation. If you or your practice is facing a charge of Medicaid fraud in Ohio, put your trust in the knowledgeable legal team at Joslyn Law Firm. Our legal team can safeguard all your legal rights and provide you with strong, affordable, and results-oriented defense representation in your criminal case from beginning to end.
To schedule a free case evaluation and legal consultation with a Columbus Medicaid fraud attorney, call us at (614) 444-1900 to learn more about how we could assist you with your legal defense, or contact us online. We help those charged in Columbus Ohio, including all surrounding counties, including Franklin County, Pickaway County, Madison County, Union County, Delaware County, Licking County, and Fairfield County, Ohio.