Expert in Medicare Fraud Defense Attorney
Michael J. Khouri, a medicare fraud attorney, has been practicing law in Orange County for over 30 years and is considered an expert in Medicare fraud defense.
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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
The City of New York is known as “the city that never sleeps.” However, due to its booming economic powerhouse as the city homes, the best and world-renowned companies in commerce and industry, the cases of Medicare Fraud have been increasing. In New York, Medicare fraudsters do not sleep – too awake in obtaining your healthcare information to submit a false claim, misrepresent a fact, and acquire payment from a government health insurance program.
Gone are the days that you should worry about your medical transactions. Our Medical Fraud Defense Lawyers will be your legal partner in prosecuting criminals and whistleblowing the underground agenda in healthcare and medical services.
We are a client-first, strategically-equipped law firm formed by dynamic and dedicated lawyers who have 20 years of proven experiences in litigating and prosecuting cases involving Anti-Kickback Statutes, False Claims Act, the Stark Law, and Medicare and Medicaid laws and regulations. Together with the law firm’s founder Atty. Michael Khouri, Atty. Behzad Vahidi, and Atty. Jennifer Gatewood, you are our family in promoting justice and fairness. Whatever it takes.
Medicare Fraud Defense Team You Can Trust
Medicare Fraud has been ruining the lives of most New Yorkers. Nowadays, Medical fraudsters have become more complex and discrete in obtaining your health data and billing insurances. Perhaps, your trusted physician, or even your reliable medical clinics, could unjustly enrich you.
You could be a potential victim. But we don’t want that to happen.
To secure your life even better, our Khouri Law Medicare Fraud Defense Team prepares the most effective and winning defense strategies just for you. Our Medicare Fraud Defense Team has successfully defended whistleblowers in Qui tam lawsuits, prosecuted notorious criminals, and recovered civil damages.
Here at Khouri Law, we protect your confidential information such as your health data, medical information, prior medical history, and hospital billings. But the security of your life is at the heart of our legal service.
Free Medicare Fraud Defense Consultation
New York City has a growing community of dynamic professionals working in healthcare and medical science. Accordingly, the highest-paying jobs in New York are working in healthcare services, including surgeons, gynecologists, family medicine physicians, dentists, and podiatrists. These professionals are at the forefront of our health and body needs, and also, can be vulnerable targets for Medicare fraud cases.
Regardless of profession or disposition in life – whether you are a beneficiary of Medicare fraud or a healthcare professional – Medicare fraudsters know nothing but only to take advantage of your health data and insurance.
Khouri Law enables opportunities for community support and advocates for justice, transparency, and accountability. As our firm’s drive to mitigate Medicare fraud cases, our defense team now offers a free consultation with your healthcare fraud-related issues. Don’t worry. You need not pay anything.
Here at Khouri Law, we believe that justice begins with the liberty to speak the truth. Get your free consultation today!
FAQ'S
What is Medicare Fraud?
Medical fraud is a critical issue that you should not overlook. Due to its complexity, learning the basics of Medicare Fraud – its nature, penalties, and core factors – ensures you a clear understanding of your case and situation.
Medicare fraud, as a general overview, is a criminal act of submitting a false claim, making a misrepresentation of fact, and illegally obtaining payment from a government health insurance program. Accordingly, it makes up about $50 billion in claims a year. Because of this, despite your earnest efforts in involving transparent healthcare transactions, you can still be a potential victim for Medicare fraud.
Five statutes are penalizing Medicare fraud cases. Hence, understanding these statutes will help you determine some particular issues involved in your case:
- False Claims Act: The act of submitting fraudulent statements with knowledge and intent to obtain federal health care payments from illegal providers.
- Stark Law: Forbidding doctors from making referrals to Medicaid or Medicare patients to designed health services (DHS), which the physicians or their immediate families have ownership, financial interest, or a compensation arrangement.
- Anti-Kickback Statute: The solicitation, payment, or acceptance of remuneration in rewarding referrals for items or services subject to reimbursement by federal programs.
- Civil Monetary Penalties Law: False claims that misrepresent a fact for items and services not provided, or presenting false claims for services or items not reimbursable by Medicare.
- Criminal Fraud Statute: The act of committing to attempt the execution of a scheme with knowledge and intent to defraud any healthcare benefit program or to obtain property or finance owned by the government through the submission of false claims.
Government Investigation: Civil or Criminal?
The investigation for Medicare Fraud involves the depth participation of various parties, including the Office of the Inspector General, the Department for Health and Human Services, the Department of Justice, the Federal Bureau of Investigation (FBI), the Medicaid Fraud Control Units, and the State Medicaid Agencies.
The verdict and determination of the case, both criminal and civil punishments, depends on your specific situation. Generally, about 1,400 individuals got indicted, while 2,500 are under Medicare criminal investigation. Thus, the threat of criminal punishment matters.
The best way to understand your case requires a one-on-one discussion with you so that we can jump into a general idea. Just put in mind that there is no guarantee that you’ll undergo a criminal investigation, so let us handle your case and determine the degree of severity for you.
What are Examples of Medicare Fraud?
There are various examples of Medicare fraud nowadays. For you to have a brief orientation, here are some commonly seen cases:
- Phantom Billing: A healthcare service provider submits billing for service not provided, including the lab tests were never performed, healthcare hours were never taken, or even billing for patients who have left or already expired.
- Double Billing: A healthcare service provider bills the patient, healthcare insurance company, or Medicare multiple times for the same services or items provided.
- Falsification of Cost Reports: A physician or any professionals working for the treatment of a patient adds unnecessary service for personal interests. Commonly, the billing includes the purchase of new cars, renovations, and other costs.
- Falsification of Patient Records: A healthcare service provider submits false statements and misrepresentation of fact through exaggerating a patient’s condition, prescription, treatment, or even surgeries, for the sole purpose of billing.
- Kickback Fraud: A healthcare laboratory or a pharmaceutical company offers kickbacks through money, gifts, or products to providers in exchange for referrals.
- Physician Self-Referrals: A physician offers facilities with which they have a conflict of interest, whether they have an immediate family member who has ownership, financial arrangement, or compensation to a designated healthcare service (DHS).
See top 10 medicaid fraud cases by clicking here.
Do you need a Medicare fraud lawyer?
Medicare fraud is a tricky and complicated issue. You may be the cause or the victim of a Medicare case. Don’t feel certain about winning or losing. What matters most are your security and your defense strategies at the early stage. Hence, a Medicare fraud lawyer will help you avoid unnecessary legal costs by providing you effective ways of prospering the case.
A Medicare fraud attorney has a high mastery of understanding legal concepts and statutes involving Medicare fraud. Committing an honest mistake with a present ignorance in the court will not ensure your full liberty. In worst-cases, without strong legal assistance, you can be criminalized.
Be sure you are prepared every step by reaching out for a consultation to determine what plans to be executed. Assess yourself first through these following questions:
- Is your employer overcharging Medicare?
- Did you discover Medicare fraud at your job?
- Are you aware of a kickback scheme or other instances of fraud?
- Did your employer suspend or demote you for promptly asking questions on suspicious events?
Get your consultation as early as now. If you’re responsible for alerting law enforcement about the Medicare fraud, you’ll be guaranteed from retaliation. However, make sure you’ve all bases covered to have a smooth investigation process.
What is the Requirement for Medicare Fraud Conviction?
The penalties of Medicare Fraud depends on the degree of the case as various offices and law enforcement agencies will handle and receive cases based on its unique circumstances.
As a general rule, if the accused is found guilty, he or she could suffer from recoupment requests, civil fines, criminal fees, exclusion from federal healthcare programs, attorney fees, criminal indictment, or even incarceration in federal prison.
Even if you played as an accomplice, or committed the felony by omission, you may still be held liable. At times, the law enforcement agency doesn’t always require proof of knowledge of the crime. Thus, getting yourself a high-caliber and world-class Medicare fraud lawyer will cover you from the start till the end of your case.
Who Is Investigated?
Healthcare fraud can involve different professionals working in healthcare services, including providers, businesses, or anyone in between, which calls for legal assistance with a healthcare fraud attorney. The main industries impacted includes:
- Hospitals
- Physician-owned entities
- Pharmacies
- Home health centers
- Laboratories
- Healthcare providers (physicians, nurses, etc.)
- Medical device companies
What is the Medicare Appeals Process?
The complexity of Medicare fraud cases involves an appeals process to undertake. Without the comprehensive guidance of a healthcare fraud attorney – who has experience in litigating Medicare fraud negotiations and cases – leads to costly risks and penalties, which would affect your liberty.
Here are the steps of the Medicare Appeals process:
- 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 should have careful and attentive undertakings. With each step requires correct evidence and argument to ensure success in moving forward. Thus, make sure to have an experienced lawyer who can provide you winning defense strategies and effective ways for your preparation.
Book you free consultation with us to get started!
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 which is why you need a healthcare fraud attorney. The main industries impacted included:
- Hospitals
- Physician-owned entities
- Laboratories
- Pharmacies
- 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!