Medicaid Fraud Audits, Defense and Compliance

Deniza Gertsberg, Esq. represents healthcare providers in responding to Medicaid and insurance investigations and audits. Our office can help devise an aggressive defense strategy and navigate through the regulatory and compliance processes.

Medicaid Fraud Audits and Defense

Our office works with medical providers subject to investigation or other attorneys who may not have a health law specialist in-house.

With federal and state governments seeking to eliminate waste and abuse, much attention has been devoted to combating medical fraud. Many medical professionals experienced this as government agencies have stepped up their auditing and investigation operations for improper reimbursements and other questionable activities going back years.

The most prominent agencies in the area of recoveries of government monies have been the states’ Offices of Medicaid Inspector General. They are tasked with detecting and investigating Medicaid fraud and abuse, recovering improperly expended Medicaid funds, enforcing Medicaid rules and regulations, auditing cost reports and claims, and reviewing quality of care given to Medicaid recipients. In New York state, for example, the Office of Medicaid Inspector General (OMIG) has been very aggressive in pursuing recoveries for allegedly improper payments and investigating allegations of fraud and abuse, since the office was established in 2006. New Jersey’s Medicaid Fraud Division (MFD) has also ramped up its fraud and abuse investigations.

The more complex and criminal fraud cases are, typically, referred to the Medicaid Fraud Control Unit (MFCU) that exists as part of the Attorney General’s office in both New York or New Jersey.

The medical provider penalties generally involve repayment of improperly billed funds, Medicaid program exclusions and terminations. Because of the severity of these violations and the technical nature of many of them, it is important for providers to consult an attorney and act immediately in response to an audit notification.

Medicaid Compliance

Compliance for medical providers is a topic of intense interest and national debate.  While individual and small group providers may have slightly more flexibility in how they can comply with regulations and guidelines, they are still expected to comply. Doctors, administrators, and billing specialists must be aware of the latest laws and compliance requirements to avoid scrutiny. The Law Office of Deniza Gertsberg provides training and consultation on many Medicaid compliance matters.

Call 732-637-9540 to speak with a healthcare attorney.