Salt Lake City Medicare and Medicaid Fraud Lawyer

Salt Lake City criminal lawyer

Attorney Darwin Overson provides experienced legal representation to individuals facing charges for Medicare and Medicaid fraud. Many medical providers and healthcare practitioners find themselves in the midst of complicated criminal proceedings related to their Medicare and Medicaid billing, coding, and referral practices. When this happens, you need a skilled criminal defense attorney who can help you navigate though the process. If you are charged with Medicare and Medicaid fraud, you may also face a substantial number of criminal charges, steep fines, imprisonment, loss of medical license, or permanent exclusion from participating in Medicare and Medicaid programs, depending on your circumstances.

If you or someone you know has been charged with Medicare or Medicaid fraud, you should contact an attorney who will fight for your rights. The team of attorneys working at the law office of Darwin Overson have the skills and experience that can help you get through this complicated situation. Darwin has been a criminal defense practitioner for over 20 years, and he is committed to relentlessly and aggressively representing clients accused of fraud. To schedule a consultation, call us at (801) 758-2287.

Fraudulent Medicare and Medicaid Criminal Charges

There is a wide variety of situations and business management blunders that can lead to criminal charges of Medicare and Medicaid fraud. Some billing and accounting problems may appear harmless, but if left uncorrected – or if seeming to establish in a pattern – they can be construed as fraud. Medicare and Medicaid criminal charges include:

  • Overbilling
  • Billing dead or false patients
  • Submitting a code for a service that was not covered or needed
  • Submitting bills for services that are not performed

All these situations above can easily occur by mistake and not reach the level of fraud in Utah, which requires a material deception. An attorney can explain what “material deception” means at greater length and when it applies.

Federal Laws Against Medicare and Medicaid Fraud

There are multiple federal laws designed to prevent Medicare and Medicaid fraud. Anyone charged for Medicare and Medicaid fraud may face charges for violating the:

  • False Claims Act, which prohibits fraud against governmental units.
  • Anti-Kickback Statute, designed to prevent remuneration in exchange for referrals for services payable by a federal program.
  • Stark Law or Physician Self-Referral Law, which prohibits referral of Medicare and Medicaid patients to service providers who have a personal or financial relationship with the referring physician.
  • Exclusion statutes prohibiting medical referrals to individuals excluded from participating in Medicare and other health care programs.

In addition to the laws described above, anyone who is investigated for violating any of these crimes can also be subject to liability for other federal crimes, such as money laundering, conspiracy and obstruction of justice. For example, failing to preserve documents can lead to further serious complicated charges for the destruction or alteration of records in a federal investigation, and even obstruction of justice. Someone guilty of obstruction can be sentenced to up to 20 years in federal prison and fined $250,000. With the support of your attorney, you can avoid finding yourself in greater complications.

Moreover, depending on the findings of your investigation, you may be charged with multiple counts for each finding of Medicare and Medicaid fraud. If you are convicted for fraud, you may end up with a fine that is double the alleged fraud amount, plus possible imprisonment and the loss your DEA license to prescribe medications. Also, there are instances when states initiate parallel proceedings for related state law violations. With the right legal representation, you can fight these allegations and obtain a reduction or dismissal of the charges.

Penalties for Medicare and Medicaid Fraud Under Utah’s False Claims Act

In Utah, the type of Medicare and Medicaid fraud charges is determined by the cumulative value of the funds or other benefits received. Depending on the alleged dollar amount, your charges can range from the more severe felony Medicare and Medicaid fraud to a class A or class B misdemeanor. The more severe penalties and associated charges include:

  • Second-degree felony convictions can result in a prison term of one to 15 years and a fine of up to $10,000.
  • A third-degree felony conviction can lead to up to five years in prison and a fine of up to $5,000.

Recovery Auditor Contractor (RAC) and Fraud Audit Programs

Many physicians and medical service providers find themselves facing Medicare and Medicaid fraud charges as a result of audits. There are Medicare audits known as Recovery Audits Programs that have a look-back period of three years concerning billing and coding practices. These audits have become more prevalent these days to correct:

  • Incorrect payment amounts
  • Non-covered services
  • Incorrectly coded services
  • Duplicate services

RACs affect most healthcare providers, and there are instances when physicians have found themselves dealing with a host of complications due to failing these audits. You can be charged with obstructing a Medicare or Medicaid audit if you fail to respond promptly and adequately to an audit request. Your attorney can help you understand this process at greater length.

Call Your Salt Lake City Criminal Defense Against Medicare and Medicaid Fraud

For anyone charged with Medicare and Medicaid fraud in Utah, the state must establish that he or she engaged in the criminal activity “knowingly, intentionally, or recklessly.” In a nutshell, all three of these types of conduct is essentially more than a mere error. Your attorney can help you understand what this means and what types of conduct typically meet the legal requirements warranting a potential criminal conviction.

Whether you are the subject of a fraud investigation or an audit, you should consider retaining an experienced attorney who can help you secure your legal rights through these procedures. Call Overson Law, PLLC, at (801) 758-2287 to schedule a free and confidential consultation.


  • This field is for validation purposes and should be left unchanged.