Federal Medicare and Medicaid Fraud
Federal Medicare and Medicaid fraud prosecutions target healthcare providers, suppliers, and organizations accused of defrauding federal healthcare programs. These cases carry prison exposure, massive civil penalties under the False Claims Act, exclusion from federal healthcare programs, and career-ending professional licensing consequences. Whether your case is in Louisville, Lexington, or anywhere in Kentucky, Clark + Harris defends Medicare and Medicaid fraud cases with the experience these prosecutions demand.
Statutory Framework
Federal Medicare and Medicaid fraud prosecutions draw on multiple statutes. The core healthcare fraud statute is 18 U.S.C. § 1347. The Anti-Kickback Statute at 42 U.S.C. § 1320a-7b criminalizes remuneration for referrals involving federal healthcare program business. The False Claims Act at 31 U.S.C. §§ 3729-3733 provides civil penalties for false claims. The Stark Law creates civil penalties for self-referrals. Money laundering, wire fraud, and aggravated identity theft charges frequently accompany the substantive healthcare fraud charges.
Common Case Types
Federal Medicare and Medicaid fraud cases in Kentucky commonly involve physician practices billing for services not rendered, upcoding, or providing medically unnecessary services; home health agencies providing or billing for unneeded visits; hospice providers enrolling ineligible patients; DME suppliers billing for unneeded equipment; substance abuse treatment providers with kickback and billing issues; and pharmacies dispensing controlled substances improperly.
Parallel Civil and Administrative Exposure
Healthcare fraud defendants typically face parallel proceedings across civil False Claims Act cases (often initiated by whistleblower qui tam actions), HHS-OIG exclusion proceedings, state Medicaid Fraud Control Unit action, professional licensing board investigations, and private insurer recoupment demands. Coordinated defense across these forums is essential — settlements in one case can devastate defenses in others.
Defense Strategies
Medicare and Medicaid fraud defense requires deep familiarity with billing rules, coding, and medical necessity standards. Defense strategies include good-faith defenses based on reliance on staff, coding consultants, or medical judgment; challenges to willfulness under Anti-Kickback Statute prosecutions; challenges to loss calculations (often heavily inflated in government theories); materiality challenges; and constitutional challenges to searches and grand jury subpoenas.
The Ruan Decision and Prescriber Cases
The Supreme Court’s 2022 decision in Ruan v. United States substantially changed the landscape for physician cases alleging controlled substance distribution outside the usual course of professional practice. Ruan requires the government to prove the defendant knowingly or intentionally acted outside professional norms, creating new defense opportunities.
Contact Clark + Harris for Medicare/Medicaid Fraud Defense
Federal healthcare fraud cases can end careers. Clark + Harris provides the experienced, discreet defense you need.
Call 859-474-0001 today for a strictly confidential consultation.
Frequently Asked Questions
How soon should I contact Clark + Harris after being charged in Kentucky?
As soon as possible. Early representation protects your rights during questioning, preserves evidence, and often leads to better outcomes. Call 859-474-0001 — we respond promptly to new inquiries.
Does Clark + Harris represent clients throughout Kentucky?
Yes. We represent clients in all 120 Kentucky counties, both state District and Circuit courts, and federal courts in the Eastern and Western Districts of Kentucky.
What happens during a free consultation with Clark + Harris?
We review the specific charges and evidence, discuss available defenses, explain the likely process in the relevant court, and give you a clear roadmap of next steps — at no cost to you.
Related Resources
If this information applied to your situation, the following Clark + Harris guides may also be helpful:
- Federal Illegal Reentry Charges (8 U.S.C. § 1326)
- Federal Public Corruption and Bribery Defense
- Federal RICO Prosecutions in Kentucky
- Kentucky White Collar Crime Defense
- Federal Criminal Defense for Kentucky Physicians: Pill Mill and Prescribing Allegations