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Medicare/Medicaid Fraud

New Jersey Medicare/Medicaid Fraud Lawyers

Experienced New Jersey Defense Lawyers Fight Allegations of Medicare and Medicaid Fraud in Essex County, Union County, Morris County, Middlesex County, Bergen County and Somerset County, NJ

Medicare and Medicaid fraud occur whenever an entity or individual receives reimbursement from one of these government programs based on the submission of false information or misrepresentation. Most Medicare and Medicaid charges are brought against medical professionals (including doctors, nurses and therapists) and organizations such as hospitals and medical clinics that receive reimbursement from these programs based upon care provided to qualifying Medicare and Medicaid beneficiaries. In New Jersey, enforcement actions designed to combat Medicare and Medicaid fraud have increased substantially in recent years, primarily via the federally-established Healthcare Fraud Prevention and Enforcement Team, which is a dedicated team comprised of officers from the Department of Justice, FBI, Department of Health and Human Services and the Inspector General’s office. 

When accused of committing Medicare or Medicaid fraud, it is important to remember that you are being accused of defrauding the federal government—meaning that the allegations must be taken extremely seriously, even if you believe you are innocent. At Zegas Law, our skilled team of criminal defense lawyers have substantial litigation experience necessary to build a bold defense against charges of Medicare or Medicaid fraud in Northern New Jersey. We understand that the various coding and billing systems implemented by these government healthcare programs can be confusing and may lead to errors that were unintentional in some cases. 

If you have been accused of committing Medicare or Medicaid fraud, or even learned that you will be subject to an audit, call or contact our office today to learn about your legal rights.

Medicare and Medicaid Fraud in Northern New Jersey

As with healthcare fraud, to establish the elements of Medicare and Medicaid fraud, the prosecution must generally show that the defendant intentionally misrepresented the facts—whether by affirmatively providing false information or omitting material information—in order to fraudulently obtain a benefit from Medicare or Medicaid. Allegations of type of fraud can take on many forms in New Jersey and often include accusations of:

  • Double billing
  • Artificially inflating medical bills
  • Phantom billing, or billing for medical care that was never received
  • Billing for patients that do not exist
  • Billing for medical care that was unnecessary
  • Up-coding or miscoding
  • Bundling or unbundling
  • Accepting kickbacks
  • Certifying medical services that were unnecessary
  • Prescribing prescription drugs that were unnecessary

Medicare and Medicaid fraud cases often involve allegations that the defendant engaged in multiple counts of healthcare fraud, which can result in significantly harsher penalties when each count of fraud is considered separately.

Healthcare Fraud Defense Lawyers Tenaciously Build Powerful Defense Plans for Clients Accused of Medicare and Medicaid Fraud in North Jersey

At Zegas Law, we have a thorough understanding of the healthcare industry and the billing practices that apply when Medicare and Medicaid are involved. Unlike many other firms, we have experience both defending clients against criminal charges and litigating in federal court. Although white collar crimes, such as Medicare and Medicaid fraud, can result in significant time in prison if convicted, Medicare and Medicaid fraud can be handled both in civil and criminal court. This makes it important to retain a lawyer with both criminal defense and litigation experience to successfully represent your interests on all sides. Both at the civil and criminal level, if you are found guilty of committing Medicare and Medicaid fraud, you could face:

  • Loss of your professional license
  • Damage to your professional reputation
  • Permanent exclusion from Medicare and Medicaid programs, meaning that your organization would never again be entitled to receive reimbursement from these and other government programs
  • Significant monetary fines for each count of fraud
  • Up to ten years in prison simply for committing the fraud, and substantially more jail time if a patient suffered serious bodily injury or died as a result of the fraud (in which case, you may face life in prison)

Our lawyers will formulate a compelling defense in your case to minimize the potential damage that allegations of Medicare and Medicaid fraud can cause, which can include alleging:

  • Insufficient evidence to find you guilty of Medicare and Medicaid fraud
  • Lack of intent to defraud
  • Permissible delegation or outsourcing of responsibilities
  • Errors that were actually caused by human error, lack of training or supervision or defects in the billing or coding processes and systems themselves

Contact our Seasoned Medicare and Medicaid Fraud Defense Lawyers to Discuss Your Case Today

The first step to building a strong defense against Medicare or Medicaid fraud allegations is to understand your legal rights. Our experienced defense lawyers have significant experience handling healthcare fraud cases, and Medicare and Medicaid fraud cases specifically, in Union County and throughout Northern New Jersey. We have a solid understanding of the healthcare industry generally and the resources necessary to go up against the government in court, so call or contact our office today to schedule a confidential consultation to discuss your case.

Frequently Asked Questions About Medicare/Medicaid Fraud

FAQ: Can I be convicted for committing Medicare or Medicaid fraud if I did not specifically intend to do so?

In some cases, you may be found to have committed Medicare or Medicaid fraud even if you did not have the specific intent to commit fraud if you recklessly disregarded the accuracy of the information you provided or acted with deliberate ignorance.  Our skilled defense lawyers will conduct a thorough investigation and analysis of the facts to build a strong case arguing that you acted reasonably under the circumstances.

FAQ: What are some of the monetary penalties that I can face if found guilty of Medicare or Medicaid fraud?

Various statutes provide for different penalties so that the monetary fines you may face will depend upon how you are charged. For example, under the anti-kickback statute, you may be fined upwards of $50,000 per violation and subject to treble damages—meaning three times the amount of the kickback. Under the exclusion statute, you may also face up to $11,000 per fraudulent claim and treble damages.  You may even be required to pay attorneys’ fees in civil cases.

Reasons to Hire Zegas Law

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ranked as top 100 nj lawyers in

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ranked as a top law firm in

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has been involved in some of the most

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has been quoted as a legal expert in

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