Audits and Criminal Charges

Orlando, Florida Medicaid/Medicare Audit Defense Lawyers

Intervening to Prevent Prosecution

The best defense is a good offense. This is more true in defending health care fraud than other types of crimes, because early intervention by a knowledgeable attorney may convince prosecutors not to bring charges. The Law Offices of Mark L. Horwitz, a Professional Association, offers proactive audit defense to avoid criminal indictments for Medicare or Medicaid fraud.

Our Orlando, Florida criminal defense firm has helped clients statewide avoid prosecutions by getting involved at the civil audit stage, before an official criminal investigation has commenced. We represent physicians and practice groups, hospital directors or employees, on-line pharmacies, and medical supply companies. We stand willing to help medical professionals statewide and nationwide respond to allegations at the civil audit stage, before criminal charges are filed.

The Audit

In most cases, it all begins with a civil audit of questionable billing practices. This can be triggered by a variety of state or federal agencies, often in concert with private insurance industry organizations dedicated to exposing health care fraud:

• Medicaid/Medicare fraud investigation units in each state, reporting to the state Attorney General's office
• The Centers for Medicare and Medicaid Services, the division of the federal Department of Health and Human Services overseeing the agencies in each state
• The National Health Care Anti-Fraud Association
• The National Insurance Crime Bureau
• The Blue Cross/Blue Shield Bureau

While these agencies use sophisticated programs to identify billing patterns and use of ICD-9 and CPT codes, they commonly reach the wrong conclusions. As Medicaid and Medicare audit defense lawyers, we conduct our own investigation — meeting with providers and employees, reviewing documents and billing codes, and interviewing potential witnesses.

Very often, ambiguities in the classification of procedures or billing codes for services are interpreted one way by providers and construed another way by civil auditors. We use every resource to demonstrate a lack of criminal intent and convince auditors that our clients were trying to comply with a complex and ever-changing system.

Criminal Charges

We help clients analyze the risks of civil litigation and criminal prosecution. For example, the Law Offices of Mark L. Horwitz, a Professional Association, defended accountants of Healthcare Corporation of America (HCA) in a high-profile case in which systemic fraud was alleged in its accounting department over filing of cost reports. Our clients were not charged in this matter.

We may push for alternatives to charges like pre-trial diversion. These agreements are not always offered and they do not preclude charges from other agencies. Criminal charges can originate from several government agencies, including:

• The FBI
• State Attorney Generals
• The Food and Drug Administration (FDA) or Drug Enforcement Agency (DEA)
• The Office of the Inspector General (Dept. of Health and Human Services)
• Defense Criminal Investigation Services (Dept. of Defense)
• The Office of Personnel Management (federal employee fraud)

We have extensive experience working with each of these law enforcement bodies, preparing for trial while negotiating possible deals to spare our clients from the worst penalties — prison time, loss of medical licensure, steep fines, asset forfeiture, and civil lawsuits. We have obtained acquittals in state and federal trials, but discuss with clients the risks associated with conviction.

Call the Law Offices of Mark L. Horwitz, a Professional Association, immediately to speak with our accomplished Medicaid/Medicare audit defense and trial lawyers. Call 407.401.7224 or 866.784.0023 or contact us online.