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3 Things to Do When Facing Medicare Fraud Charges

Healthcare service providers have become all too familiar with fraud allegations and misdirected accusations. In 2021, more than a hundred healthcare service providers were charged and it is even reported that over a billion dollars were allegedly lost in connection to healthcare fraud.

With that, everyone working in the healthcare industry runs the risk of facing fraud allegations at some point in their career. So to help you avoid or at least get past this, we have listed a few things you can do when facing fraud charges.

Respond and Act Immediately

Healthcare fraud is a white-collar crime that can range from unintentional non-compliance to voluntary receiving kickbacks. That said, the very first thing that you should do is to hear and understand the allegations against you or your health institution. This way, you can immediately act on it and prevent any further damages from happening.

Remember that handling allegations and squaring off in court can be a long tedious process. So to prevent worsening the situation as well as save you from incurring any more hefty fines, you should at least understand the situation first and then immediately find ways to resolve it.

For instance, your clinic has been accused of upcoding. But from your perspective, it was an unintentional mistake. In that case, you should prove that the accusation was in fact unintentional and that you are finding ways to not let it happen again. This entire process requires a swift response and action not just from you but your entire healthcare team as well. Should you find out that there is a mistake in your coding process, then you should immediately remedy the situation and address the problem in your system.

Know your Penalties

Keep in mind that penalties can range from civil, criminal, and/or administrative. Once you found out that you are in violation, then you should immediately rectify the situation and find ways to offset any damages that you or your institution have caused.

In the case of healthcare fraud, almost all violations require some sort of monetary fine or sanction. What you should always look out for are administrative or criminal sanctions. Administrative sanctions can cause you your medical license as well as your clinic’s ability to operate, whereas criminal sanctions might lead to hefty fines plus incarceration. Knowing this can save you a lot of time and resources.

For example, rather than resolve the charges by litigation (which tend to be costly), you can instead arbitrate or compensate for the damages you have done. You can only opt for the second option if you know the cost of your penalty. Only then can you weigh the pros and cons of going into a costly legal battle such as litigation.

Get Help

As mentioned, administrative and criminal sanctions are a different league of penalties. Once you are sanctioned with these penalties, then chances are the allegations against you require further evidence and investigation. Cases like these are best handled with a medicare fraud lawyer or attorney. They can guide you through the entire legal process, gather all the necessary documents, and even provide advice on how you can avoid these allegations from happening ever again.

Having someone who can guide you through the entire legal process can also make a big difference. They can help you lower your sanctions and even enable you to win your case in court.

Just keep in mind that when it comes to getting help from these lawyers, you should always check their track record and make sure that they can effectively handle your case. Check for things such as their years of experience, previous cases they handled, and so on.


There is no formula when it comes to facing Medicare fraud charges. Given that healthcare fraud cases tend to vary, most of the time, the best thing that you can do is to simply assess the situation and find a lawyer who can help you.

Remember that as a medical professional, it is not just sanctions or penalties on the line. Your career as a healthcare service provider is also at stake every time you face these allegations or charges. Given that you have a big responsibility to your patient, it is only right to always avoid and resolve these allegations at all costs.

Because at the end of the day, patients entrust you with your life. With that, the very least thing that you should do is to make sure that trust is never stained or corrupted.

1 Comment

Daniyel Reachard
Daniyel Reachard
May 25, 2023


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