Ask a Medical Fraud Attorney: 11 Frequently Asked Questions


Are you struggling to find accurate information after being accused of healthcare fraud? You’re in the right place. We’ve addressed many of your concerns below, and your medical fraud attorney can answer any more questions that we haven’t covered. Obtaining accurate answers to legal questions is vital, so let’s get started.

Ask a Medical Fraud Attorney: 11 Frequently Asked Questions

1. What Are the Most Common Forms of Healthcare Fraud?

If you’re being accused of healthcare fraud, then you’re probably being accused of one of the following:

  • Billing for services you didn’t perform
  • Billing twice
  • Medicare and Medicaid fraud
  • Performing unnecessary procedures or prescribing unnecessary medications
  • Unbundling or upcoding medical services

Experienced medical fraud defense lawyers can defend you from all of these claims and more.

2. What Is Qui Tam?

Qui tam is a legal term used to describe a whistleblower under the False Claims Act. This means a person, usually an employee, that reveals illicit or immoral information about an organization to the public. In healthcare fraud, this means the person accusing you of fraud is most likely a colleague and not a patient.

3. What Do I Do If I’m Being Sued for Medicaid Fraud?

If you’re being sued for medicate fraud, don’t respond to the lawsuit. Any communication from you could be used against you in court. Contact an attorney straight away. Your attorney will examine the lawsuit and explain what you should do next.

4. What Should I Do If I’m Being Accused of Another Form of Healthcare Fraud?

The same rules to the question above apply here. Don’t respond, even if you believe the claimant’s case has no merit. Anything you attempt to say in your defense could instead strengthen their case. Let your attorney handle all the communications involved.

5. What Should I Do If I’ve Been Falsely Accused?

We know this situation is incredibly frustrating for you. You’ve worked to establish an excellent reputation and build your practice. However, it doesn’t matter whether you’re certain you’re completely innocent here. Anything you say or do now could hurt your case. Explain to your attorney exactly why the claim is fraudulent, and that will help them start building a case to defend you.

6. Can Medical Fraud Claims Make Me Lose My Medical License?

Yes, under certain circumstances, it is possible to lose your medical license if you’re found guilty of medical fraud. You’re most likely to lose your license if your fraud was unethical or violated a federal or state law. If you’ve been falsely accused, then an experienced attorney will be able to prove this and help save your license regardless of what you’re being accused of.

7. Should I Offer the Whistleblower a Financial Settlement?

It can be so tempting to offer a financial settlement, as it seems like it will make this case end sooner. However, if you make an offer, there could be legal ramifications you didn’t intend. The whistleblower may attempt to call the settlement you offer a bribe. This will act against your case. They may also view your offer as you admitting your guilt. It’s best not to do anything and instead let the legal path take its course.

8. Do I Need to Speak to My Insurance Provider When I’ve Been Accused of Fraud?

Ideally, you should speak to as few people as possible. This includes your insurance provider. If your insurance provider needs to be contacted, then your attorney will do it for you.

9. Should I Speak to a Prosecutor?

Speak to an experienced defense attorney before you talk to any form of law enforcement about medical fraud claims. Your attorney will defend you and deal with law enforcement, including prosecutors.

10. Could I Go to Prison If I’ve Been Accused of Medical Fraud?

If you truly have committed a healthcare fraud violation, then you most likely won’t be incarcerated. Most healthcare fraud cases are civil violations. These typically don’t involve any time in prison or jail. However, you may become the focus of a lawsuit big enough to bankrupt your practice. You could be subject to fines and a severely damaged reputation on a smaller scale.

11. How Vital Is It to Hire Healthcare Fraud Defence Attorney?

As you’ve read above, anything you say or do could help strengthen the whistleblower’s case. You need an attorney to help you know your rights and understand your case. Your attorney will also handle all communications throughout these legal proceedings. Your attorney can help get you a lesser charge, and you’ll need them to defend you in the courtroom, too.

We understand how terrifying it must be for you if you’ve been accused of medical fraud. Nevertheless, an experienced attorney will do everything in their power to ensure you come out of this case with as little damage to your reputation, practice, and finances as possible.

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