Medicare and Medicaid Fraud

Facing Federal Medicare or Medicaid Fraud Charges? Andrew M. Weisberg Can Help Protect Your Rights

Medicare and Medicaid fraud charges are among the most aggressively prosecuted federal offenses. Investigations often involve detailed audits, financial records, and months or even years of review before charges are filed. A conviction can result in lengthy prison sentences, massive financial penalties, and permanent damage to your professional reputation. If you are under investigation or facing federal Medicare or Medicaid fraud charges, you need experienced legal representation immediately.

Andrew M. Weisberg is a Chicago criminal defense attorney and former prosecutor who represents individuals and professionals accused of serious criminal offenses, including complex federal fraud allegations. He works closely with clients to develop strong defense strategies designed to protect their freedom, professional licenses, and financial future.

Understanding Medicare and Medicaid Fraud Under Federal Law

Medicare and Medicaid fraud cases are prosecuted under several federal statutes. The most commonly used laws include:

• 18 U.S.C. § 1347 – Health Care Fraud
• 31 U.S.C. §§ 3729–3733 – False Claims Act
• 42 U.S.C. § 1320a-7b – Anti-Kickback Statute

These laws make it illegal to knowingly submit false claims to government healthcare programs or to engage in schemes designed to obtain payments that are not legitimately owed.

Healthcare fraud investigations often involve agencies such as:

• The FBI
• The Department of Health and Human Services Office of Inspector General (HHS-OIG)
• Medicare Fraud Strike Forces
• Federal prosecutors from the U.S. Attorney’s Office

Investigations frequently begin with audits or billing reviews before escalating into criminal cases.

Common Types of Medicare and Medicaid Fraud Allegations

Healthcare fraud cases often involve complicated billing systems and documentation. In many situations, what begins as a billing dispute or administrative issue can later become the basis for criminal allegations.

Common allegations include:

Billing for Services Not Provided

Prosecutors may claim that claims were submitted for procedures, tests, or visits that never occurred.

Upcoding

Upcoding involves allegations that a provider billed for more expensive services than those actually performed. These cases often depend on interpretation of medical records and billing codes.

Kickbacks and Referral Payments

Federal law prohibits offering or receiving compensation in exchange for patient referrals involving Medicare or Medicaid. These cases may involve business arrangements that prosecutors claim were improper.

Unbundling of Services

Unbundling allegations arise when prosecutors claim that services normally billed together were improperly billed separately in order to increase reimbursement.

False Cost Reports

Healthcare providers may face charges if prosecutors allege that reimbursement requests included inaccurate financial information.

Prescription-Related Fraud

Cases may involve allegations that prescriptions were medically unnecessary or that medications were billed but not provided.

Many healthcare fraud cases hinge on whether the government can prove intentional wrongdoing rather than mistakes or poor recordkeeping.

Penalties for Medicare and Medicaid Fraud

Federal healthcare fraud charges carry extremely serious penalties.

Potential penalties include:

• Up to 10 years in federal prison for healthcare fraud
• Up to 20 years or more if serious bodily injury is alleged
• Substantial criminal fines
• Treble damages under the False Claims Act
• Restitution to government programs
• Asset forfeiture
• Supervised release following imprisonment
• A permanent federal criminal record

In addition to criminal penalties, individuals convicted of healthcare fraud often face mandatory exclusion from Medicare and Medicaid programs, which can end a healthcare career.

Additional Charges Often Filed in Healthcare Fraud Cases

Healthcare fraud investigations frequently lead to multiple federal charges arising from the same alleged conduct.

Common related charges include:

• Conspiracy (18 U.S.C. § 371)
• Wire Fraud (18 U.S.C. § 1343)
• Mail Fraud (18 U.S.C. § 1341)
• False Statements (18 U.S.C. § 1001)
• Money Laundering (18 U.S.C. § 1956)

Multiple charges can dramatically increase potential sentencing exposure.

Consequences Beyond Criminal Penalties

A Medicare or Medicaid fraud conviction can affect every aspect of a person’s professional and personal life.

Long-term consequences may include:

• Loss of medical or professional licenses
• Exclusion from Medicare and Medicaid participation
• Loss of employment or business opportunities
• Financial hardship from restitution and fines
• Damage to professional reputation
• Difficulty obtaining credit or loans

Healthcare fraud convictions often end professional careers, making early legal representation especially important.

Defending Medicare and Medicaid Fraud Charges

Federal healthcare fraud cases often involve massive amounts of documentation, billing records, and financial evidence. A successful defense requires careful analysis and strategic planning.

Andrew M. Weisberg works with clients to identify weaknesses in the government’s case and develop strong defenses tailored to the facts.

Possible defense strategies may include:

• Lack of intent to defraud
• Legitimate medical or business practices
• Billing errors or administrative mistakes
• Disputes over medical necessity
• Insufficient evidence of a fraudulent scheme
• Misinterpretation of billing regulations
• Violations of constitutional rights during the investigation

Early legal involvement is especially important in healthcare fraud cases. In some situations, working with an attorney early in an investigation can significantly improve the outcome.

Why Choose Andrew M. Weisberg

Andrew M. Weisberg is an experienced Chicago criminal defense attorney who has represented clients facing serious criminal allegations throughout Cook County and the surrounding area.

As a former prosecutor, he understands how fraud cases are built and how investigators gather evidence. He uses that experience to protect his clients and challenge the government’s case.

Clients who choose Andrew benefit from:

• Direct communication with their attorney
• Careful review of financial and billing records
• Strategic and practical legal advice
• Strong courtroom advocacy
• Personalized attention throughout the case

Andrew personally handles every case and works closely with clients at each stage of the legal process.

The Importance of Acting Quickly

If you believe you may be under investigation for Medicare or Medicaid fraud, it is important to seek legal advice immediately.

Federal investigators often contact healthcare providers or business owners before charges are filed. Statements made during these early contacts can later be used as evidence.

Speaking with an attorney before responding to investigators can help protect your rights and your future.

Speak With Andrew M. Weisberg Today

If you or a loved one is facing federal Medicare or Medicaid fraud charges, you should speak with an experienced defense attorney as soon as possible.

Call (773) 908-9811 to reach Andrew M. Weisberg directly for a free consultation, or fill out the Case Review form on this website to request a prompt response.

Early legal representation can make a critical difference in protecting your freedom, your reputation, and your professional future.