Expert in Medicare Fraud Defense
Michael J. Khouri has been practicing law in Orange County for over 30 years and is considered an expert in Medicare fraud defense.
Let us use our 30 years of experience to help your legal case.
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Tackling complex cases & seeing them through
When you are under investigation for phantom billing or up-coding, or accused of billing medically unnecessary services, you need an attorney who has witnessed similar cases.
Commitment to help with difficult cases
Invest your time and resources intelligently into a strategic and thoughtful defense plan with Michael J. Khouri, an attorney who has decades of experience.
Eliminate Your Stress
Medicare fraud defense can be a stressful process but it does not have to be if you are represented correctly. Gain peace of mind knowing that you are in good hands.
Medicare Fraud Defense Lawyers
Prosecuting Medicare Fraud is a top priority of the government. Each US Attorney’s office in every federal district has prosecutors specially assigned to prosecute fraud cases. And, every FBI and OIG Office has agents assigned to investigate healthcare fraud. Anyone who bills Medicare is a possible target.
Khouri Law Firm defends criminal investigations and defends against professional license disciplinary matters. Our firm understands the relationship between all these moving parts.
Consolidation of all issues leads to a better result at a reduced cost. We understand the importance of having experts in medicine, coding, billing processes, and statistical analysis of data that can be critical in reducing or eliminating any fines incurred. Khouri Law Firm will go on the offensive to get you the best possible outcome.
Medicare Fraud Defense Team You Can Trust
Michael J. Khouri has been practicing law in Orange County for over 30 years and is considered an expert in professional licensing defense of Medicare audits. He specifically has a long list of experience with representing health care providers, leading to his great reputation throughout California for his integrity and dedication to getting his clients the best possible resolution to their licensing or criminal matters.
Khouri’s associates Behzad Vahidi, Esq. and Jennifer Gatewood are also passionate members of the fraud defense team. Behzad is an associate attorney of professional experience in criminal defense. Jennifer was Staff Attorney and Director of Pro Bono at a children’s legal non-profit organization. She has a specialty in areas of health care fraud and abuse, making her a critical part keeping the team at its best with all Medicare fraud cases.
Free Medicare Fraud Defense Consultation
Making sure you feel comfortable with your fraud defense lawyers is the most important part of the process, so we make sure to map out time in our schedule for free Medicare fraud defense consultations to help give you a better idea of what can offer. Plus, we will be happy to share insight on your specific circumstances to make sure you feel prepared for the road ahead. Call us today to take advantage of our in-depth industry experience and knowledge.
What is Medicare Fraud?
Knowing the basics of Medicare fraud is crucial to understanding your own case and situations, and we want to make sure you are as caught up as possible. Medicare fraud generally refers to instances of submitting false claims to a government health care program, an issue that makes up about $50 billion in claims a year. Because of this, there is always a chance that you will be audited, no matter how much work you put into playing things by the books.
There are five statutes you should understand when it comes to Medicare fraud to fully grasp what you’re expected to comply with:
- False Claims Act: Knowingly submitting fraudulent statements to obtain federal health care payments to which the provider is not entitled.
- Stark Law: Making prohibited referrals to an entity in which the physician or their immediate family has ownership, financial interest, or a compensation arrangement.
- Anti-Kickback Statute: Knowingly soliciting, paying, or accepting remuneration to reward referrals for items/services that are reimbursed by federal programs.
- Civil Monetary Penalties Law: Presenting a claim that is for an item/service not provided as claimed or one that is fraudulent or false. This could also be for presenting a claim for an item/service not reimbursable by Medicare.
- Criminal Fraud Statute: Knowingly executing or attempting a scheme to defraud any health care benefit program or to obtain money/property owned by a health care benefit program by means of false pretenses.
Government Investigation: Civil or Criminal?
Medicare fraud is investigated in depth by many different parties, including the Office of Inspector General, the Department for Health and Human Services, the Department of Justice, the FBI, Medicaid Fraud Control Units, and State Medicaid Agencies.
If found guilty, both civil and criminal punishment could be in order depending on your specific situation. To paint a general picture, about 1,400 individuals are indicted while 2,500 are under Medicare criminal investigation, so the threat of criminal punishment is very real.
The best way to know what your specific situation entails is to really sit down and discuss it with you so that we can have a general idea. Just know that there is no guarantee that you will be under criminal investigation, so let us handle your case and determine the severity for you specifically.
What are Examples of Medicare Fraud?
There are many different examples of Medicare fraud, so it can be hard to keep track. Here are some commonly seen cases:
- Phantom Billing: this is submitting billing for services not provided and is one of the most common types of Medicare fraud. It could involve tests that were never taken, healthcare hours not provided, or even billing for patients who have already left or died.
- Double Billing: this is when the provider attempts to bill the patient, insurance company, or Medicare multiple times for the same treatment.
- Falsification of Cost Reports: this involves adding personal expenses under the guise of professional expenses related to treatment of patients. Cases of this have included billings for new cars, renovations, or other personal costs.
- Falsification of Patient Records: this can be done in order to falsely prove a need for gratuities treatments, prescriptions, or even surgeries for the sole purpose of billing.
- Kickback Fraud: this refers to instances when laboratories or pharmaceutical companies offer kickbacks through money, gifts, or products to providers in exchange for referrals.
- Physician Self-Referrals: as mentioned earlier, physicians may not offer referrals to facilities with which they have a conflict of interest (they or an immediate family member have financial involvement).
Do you need a Medicare fraud lawyer?
If you feel certain that aren’t in the wrong or that your case will be in your favor, or if you are simply in the early stages of auditing, it could be understandable to wonder if you even need a Medicare fraud lawyer in the first place.
Do not make the mistake of going into this alone. Even if you made an honest mistake, this is often not forgiven when it comes to these cases. Be sure you are prepared every step of the way by reaching out for a consultation to determine which steps you should be taking.
Basic questions you should ask yourself if you are concerned about this include:
- Have you uncovered Medicare fraud at your job?
- Is your employer overcharging Medicare?
- Are you aware of a kickback scheme or other instances of fraud?
- Have you been fired/demoted for asking questions when things seem suspicious?
Make sure you get help or advice early. If you are the one to alert law enforcement about fraud, you will be protected from retaliation, but you want to make sure you have all your bases covered if something doesn’t feel right.
What is the Requirement for Medicare Fraud Conviction?
Struggling to find this information.
What are the Penalties
Medicare fraud is investigated by a number of different offices and teams, and every case can be handled and received differently based on its unique circumstances.
If the target of investigation is found guilty, they could face recoupment requests, civil fines, criminal fees, exclusion from federal health care programs, attorney fees, criminal indictment, or even incarceration in federal prison.
Even if you did not have explicit intent to violate the law, you may still be held liable for any role you played. The government does not always even require proof of knowledge of the wrongfulness, so making sure you are covered by an excellent Medicare fraud lawyer is vital.
Who Is Investigated?
Health care fraud can impact a wide range of people, whether they be providers, businesses, or anyone in between. The main industries impacted included:
- Physician-owned entities
- Home health centers
- Healthcare providers (physicians, nurses, etc.)
- Medical device companies
What is the Medicare Appeals Process?
With the complexity of Medicare fraud cases, there is, of course, an appeals process to understand as well. Taking on this process without experienced attorneys is a massive mistake that could lead to costly risks and penalties, many of which could be avoided.
The steps of the Medicare appeals process are:
- Redetermination by a CMS contractor (Centers for Medicare & Medicaid Services)
- Reconsideration by a qualified contractor
- Hearing before an administrative law judge
- Review by an appeals council
- Judicial review in federal district court
All five steps require meticulous care and attention to provide the correct evidence and argument to ensure success in moving forward. Be sure to have an experienced lawyer making these steps with you so that you are informed and prepared.
Book you free consultation with us to get started!