How Should I Respond to a North Carolina Medicaid Fraud Investigation?

By KevinMarcilliat, In Medicaid Fraud, 0 Comments

At the Marcilliat & Mills PLLC, our skilled Raleigh criminal defense attorneys and support staff protect the rights of physicians, dentists, counselors, pharmacists, group practices, and other healthcare professionals and organizations when they are being investigated for Medicaid fraud in North Carolina.

Our Wake County Medicaid fraud lawyers know that by the time healthcare professionals receive a letter from an investigator requesting documents or an interview, they have already gathered the evidence they need to believe they have engaged in fraudulent behavior.

Anything you say at this point can and will be used against you.

You have the right to consult with an experienced Medicaid fraud defense lawyer before answering any questions. You also have the right to bring an attorney with you to any interviews or meetings with a Medicaid fraud investigator.

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.

Here is what Medicaid healthcare providers need to know about their rights, the investigation process, and how we can help.

Who Investigates Medicaid Fraud in North Carolina?

The North Carolina State Bureau of Investigation and the Medicaid Criminal Investigation Unit investigate fraud committed by Medicaid healthcare providers throughout the state.

A Medicaid provider is defined as any individual, corporation, or another entity, and their officers and employees, paid by Medicaid for providing a health care service.

Medicaid provider fraud cases are led by highly specialized law enforcement teams that investigate embezzlement, theft, violations of federal sanctions, and the improper commingling of patients’ funds in Medicaid-funded facilities.

The Medicaid Criminal Investigations Unit works with North Carolina Department of Justice attorneys, investigators, and auditors, all of whom are trained in the complexities of healthcare fraud investigations and litigation. The unit also works closely with United States attorneys, district attorneys, federal and state law enforcement agencies, and private insurance company fraud units.

State and federal investigations and audits involving provider billing can result in the provider appearing in an Office of Administrative Hearing, career-ending criminal charges, or civil liabilities.

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. Our Marcilliat & Mills PLLC Medicaid defense lawyers can help you develop a strategic legal defense, so you can make informed decisions about the direction of your case.

What are the Most Common Types of Medicaid Fraud in North Carolina?

Medicaid fraud can take many different forms in North Carolina.

Examples of fraud amongst healthcare providers may include, but are not limited to:

  • 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.

If you receive a record request from a Medicaid investigator, it may be that you are a target of an investigation, or your records are needed for other evidentiary reasons. Depending on the nature of the investigation, this may include Medicaid and non-Medicaid patient charts or business records that include provider and patient schedules and billing records.

It is illegal to hinder a criminal investigation, which means you must cooperate with a subpoena for your records, if law enforcement presents one. Then, you should immediately contact our Medicaid fraud defense attorneys in Raleigh to understand your rights and obligations, as well as any criminal and civil liabilities that you or your practice might face.

Contact our skilled Medicaid criminal defense attorneys in Raleigh at the Marcilliat & Mills PLLC today by calling (919) 838-6643 or contact us online to schedule a free consultation to learn how we can empower you to take a stand and pursue the best outcome for your unique legal circumstances.

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