How Are Investigations Conducted For Medicare And Medicaid Fraud?

Investigations for Medicare and Medicaid Fraud can result in very serious consequences. From severe fines to restitution and prison time, the penalties for a conviction can be debilitating to a person’s career, reputation, and overall well-being. When facing a life-changing sentence, an experienced and aggressive Omaha criminal defense lawyer can guide you through the process and help defend your rights. Berry Law’s attorneys have decades of knowledge on their side, and the relentless tenacity to fight for our clients during every stage of a legal battle.

Some examples of Medicare and Medicaid fraud include accusations of:

  • Phantom billing (billing for medical services not actually performed)
  • Coding (billing for a more expensive service than what was performed)
  • Unbundling (billing for several services normally combined into one bill)
  • Billing twice for the same medical service
  • Billing for brand-name drugs while selling generic
  • Direct kickbacks in return for particular medical services
  • Bribery
  • Providing unnecessary services
  • False cost reports
  • Embezzlement of recipient funds

Investigations into these charges will frequently involve the Office of Inspector General for the U.S. Department of Health and Human Services, who will work closely with the FBI in building a case against the accused. In order to defend the rights of the individual citizen, Berry Law works tirelessly to develop defense strategies for our clients that allow them to avoid being railroaded by the resources of large government organizations.

In addition to the possibility of criminal indictment, all Medicare and Medicaid fraud cases have the potential to turn into civil complaints and state professional licensing complaints. Because many local governments are dedicating increasing amounts of resources to investigating this kind of fraud, many providers are subject to investigations related to smaller billing discrepancies. Minor mistakes may be pursued with a heavy hand.

Medicaid audits are conducted in response to complaints from patients or Medicaid plans. A state agency will use several fraud detection methods including data mining and comparing a provider’s claims against similar providers in the same area. If fraud is suspected, the ensuing case could have devastating consequences if not met with a quick and methodical legal defense.


Berry Law is comprised of trusted and determined lawyers who will relentlessly help you seek justice. To enter this legal process with confidence in your defense team, contact the respected Omaha criminal defense lawyers at Berry Law.

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