Medicaid Fraud

The procedures for properly billing Medicaid are complicated, and far too often, a Medicaid billing audits turn into investigations with billions of dollars at stake. Gardere’s Medicaid fraud attorneys understands the complexities of the Medicaid laws and has hands-on experience working with government lawyers and officials. We assist health care providers with:

  • Audit responses
  • Investigations
  • Settlement negotiations
  • Litigation, civil and criminal
  • Litigation avoidance strategies

Our team, which includes a former top litigator from the Texas Attorney General's Office and a former assistant Texas Attorney General, has working knowledge of the government process and has built close relationships with the National Association of Attorneys General, numerous health departments and the federal government. We can help providers devise smart legal strategies to deal with the broad array of legal problems that arise when facing either a single-state or multistate legal challenge.

About Medicaid Fraud

Medicaid is a federal/state cost-sharing program that provides health care to people who are unable to pay for such care. Medicaid provider fraud involves making false or misleading statements, or causing such statements to be made, in order to get Medicaid reimbursement. Federal law grants far-reaching authority to Medicaid Fraud Control Units across the country to investigate allegations of fraud and abuse involving the Medicaid program. Most Medicaid Fraud Control Units fall under the umbrella of the state attorneys general, including the Texas Attorney General's Office.

Providers include anyone who or any entity that is paid for providing health care services to Medicaid beneficiaries, such as:

  • Doctors
  • Dentists
  • Hospitals
  • Pharmaceutical companies
  • Medical equipment companies
  • Nursing homes
  • Pharmacies
  • Ambulance companies
  • Licensed professional counselors
  • Adult day care centers
  • Case management centers

Some examples of Medicaid fraud include:

  • Billing for services not delivered
  • Double billing
  • Billing for unnecessary services or procedures
  • Substituting generic drugs for brand name drugs
  • Billing for phantom visits
  • Kickbacks

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