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Attorney General Medicaid Audits
Attorney General Medicaid Audits
At Spodek Law Group, we understand that if you’re here, you’re facing a serious situation – and you need legal help. Attorney General Medicaid audits aren’t just simple reviews. These audits can escalate quickly, sometimes leading to federal-level scrutiny and harsh criminal allegations. If you’re under investigation, you need a team that knows how to dismantle the government’s case, challenge the evidence, and fight for your future. Our attorneys have over 50 years of combined experience doing exactly that, and we’re here to help you.
Why Attorney General Medicaid Audits Can Spiral Out of Control
When an Attorney General initiates a Medicaid audit, there’s always a risk that federal authorities, like the Department of Justice (DOJ), may join in if they see potential violations of 18 U.S.C. § 1347 (health care fraud) or other federal statutes. Since Medicaid is a joint federal-state program, the government often argues federal funds are at stake. Once that argument sticks, you could face stricter penalties under the Federal Sentencing Guidelines. We’ve seen cases where a minor billing dispute morphs into allegations of wire fraud (18 U.S.C. § 1343), money laundering (18 U.S.C. § 1956), or conspiracy (18 U.S.C. § 371).
State vs. Federal Charges and the Double Jeopardy Question
If the state Attorney General’s office is investigating, you might assume it protects you from being charged again at the federal level. Unfortunately, it doesn’t. Double jeopardy does not necessarily apply when two different sovereigns bring charges. At Spodek Law Group, we work to keep you from facing overlapping investigations. We coordinate a strategic response that targets the crux of the government’s allegations. Our attorneys know how prosecutors think, and we build defenses that push back on each step of their case.
Potential Penalties and Collateral Consequences
A conviction at the state level can mean hefty fines, probation, or prison time. If the federal government steps in, those penalties can skyrocket due to mandatory minimums. Plus, conviction might mean exclusion from Medicaid, Medicare, and other federal programs under 42 U.S.C. § 1320a-7. For many clients, that’s a career-ending blow. Our goal is to protect you from these life-changing consequences. We start by challenging the government’s evidence, scouring every record, and working 24/7 to expose any gaps in the case against you.
Defense Strategies: Exploring Scenarios and Solutions
No two situations are identical. We tailor our approach based on the specifics of your audit or investigation. Below are just a few scenarios that illustrate how we might strategize.
Scenario A: Alleged Billing Errors
If the government claims you “upcoded” or billed for services not rendered, we look at whether you had an internal compliance system. We bring in forensic experts, examine the software you used, and compare your claims history against industry standards. Our goal is to prove there was no criminal intent. If we show these were honest oversights, prosecutors lose their footing.
Scenario B: Whistleblower-Driven Investigations
Disgruntled former employees can trigger Medicaid fraud probes by alleging intentional overbilling. We investigate the whistleblower’s background, check for ulterior motives, and analyze your historical billing data. If we can show the accuser has limited credibility and your records support legitimate claims, we shut down the whistleblower’s allegations at the outset.
Scenario C: Criminal Exposure for Conspiracy or Money Laundering
Sometimes the government layers on bigger federal charges like conspiracy (18 U.S.C. § 371) or money laundering (18 U.S.C. § 1956). We aim to poke holes in every element of the alleged scheme. If the prosecution can’t establish that you knowingly joined a conspiracy, or can’t link your finances to illegal activity, we push for dismissal or reduced charges. This approach keeps you from facing lengthy prison sentences that typically follow these enhanced accusations.
Scenario D: Plea Bargains vs. Trials
Clients often ask whether it’s better to negotiate a plea or fight at trial. This depends on the evidence, the strength of witness testimony, and the potential sentencing outcomes. If the government’s case is shaky, we may hold firm for dismissal or go to trial. But sometimes a plea agreement that reduces charges is the best way to guard your future. Either way, our attorneys keep you informed at every step so you can make the smartest decision.
TABLE: KEY DIFFERENCES BETWEEN STATE AG MEDICAID AUDITS AND FEDERAL MEDICAID FRAUD CASES
| Aspect | State AG Audits | Federal Cases | Potential Penalties | Our Focus |
|---|---|---|---|---|
| Investigation Authority | Attorney General / State MFCU | DOJ, OIG, FBI | Fines, probation, jail time | Examine claims for honest mistakes |
| Trigger | Complaint, routine audit | Evidence of federal fund misuse | Longer sentences, higher fines | Fight for dismissal or reduced charges |
| Legal Standards | State penal codes / regs | Federal statutes (18 U.S.C. §§ 1347, etc.) | Mandatory minimums in some cases | Challenge each element of the charge |
| Defense Focus | Prove lack of criminal intent | Question federal jurisdiction | Permanent exclusion from programs | Create a strong pre-trial strategy |
How We Push Back on Evidence
We treat evidence as the backbone of any prosecution. If the government’s case is built on weak or unlawfully obtained records, we leverage that. We file motions to suppress. We question how investigators collected data. We highlight any sign of government overreach. If search warrants were executed incorrectly, or if you were coerced into a confession, we bring that to the court’s attention immediately. We have a dedicated team of criminal defense attorneys who’ve handled high-stakes investigations nationwide – from New York to California – and we know how to discredit shaky evidence.
Addressing Rare or Overlooked Issues
Some providers operate across multiple states, so the jurisdictional lines can blur. In other situations, third-party billing companies make errors that appear fraudulent. We clarify who controlled the claims submission process. If the real issue is sloppy bookkeeping by an outside vendor, we make that clear to prosecutors. By showing that you lacked any intent to defraud, we weaken the government’s arguments for criminal liability.
Choosing the Right Approach
Sometimes, building a cooperative relationship with the investigating agency leads to a better outcome. Other times, it’s necessary to stand firm and contest every allegation. At Spodek Law Group, our only loyalty is to our clients. We look at the evidence, examine the prosecutors’ stance, and decide whether a collaborative or adversarial approach works best for your circumstances.
We’re Here 24/7 and We’re Ready to Help
Attorney General Medicaid audits can quickly turn your life upside down. We know that every day matters when you’re under this kind of pressure. Our attorneys are available 24/7 because we understand how stressful it is. When you hire us, you get a firm that’s recognized nationwide, with a track record of handling tough federal and state cases. We’re selective about who we work with, because we want to ensure we can truly help every single client who comes to us. That means when we take your case, we’re serious about winning.
Spodek Law Group – We Fight, We Negotiate, We Defend
The next step is reaching out for a risk-free consultation, so you can discuss your situation openly. We won’t promise easy fixes. But we will promise to use our 50+ years of combined experience to protect you. We aim to give you the best possible legal representation at every stage of your case. If you want a legal team that’s laser-focused on your future and unafraid to challenge the government, talk to us.