Medicare / Medicaid Fraud
Medicare and Medicaid are federal programs. That means that any accusations of defrauding those programs are federal charges, which will be heard in federal court. Your attorney should not only be familiar with the intricacies of federal court and federal procedure, but also with the complicated legal matters that are involved with any fraud case.
Des Moines Medicare Fraud Lawyer
If you’ve been accused of Medicare or Medicaid fraud, a Des Moines fraud lawyer from McCarthy & Hamrock, P.C. has the skills you’re looking for to effectively fight the charges. At McCarthy & Hamrock, P.C., we have four decades of experience to put to work for you. We will build the strongest defense possible, challenging the prosecution’s evidence and seeking to have your charges reduced or dismissed. Call us today at (515) 279-9700 to set up a free consultation.
We are licensed to practice in Iowa federal courts, and based in West Des Moines. We represent clients throughout the Des Moines area, including anywhere in Polk County and Dallas County, and throughout the state of Iowa.
Medicare and Medicaid Fraud Charges in Iowa Federal Courts
More than 1 million people are enrolled in either Medicaid or Medicare in Iowa, and numbers are growing rapidly. Medicare is a program that is intended to primarily serve as health insurance for the elderly. Medicaid mostly aids those with low or no incomes, who do not make enough money to be able to afford health insurance. Under the programs, the program beneficiary seeks services through a doctor or other health care provider, and the provider bills Medicare or Medicaid for the services rendered.
The doctor, clinic or health care provider is often the subject of the criminal accusations. Under federal law, it is illegal to knowingly bill for services that were not performed, or bill for supplies or medical equipment that were not provided. Under the law, this includes billing for appointments that the patient did not make. Often, the provider is accused of billing Medicare or Medicaid for serves not provided, or for services not deemed medically necessary.
For example, a doctor may be accused of offering much more physical therapy than a patient needs, and then bill Medicare for all of the physical therapy. He or she may also be accused of offering the patients money, food or other services to allow the doctor to use their names to bill the program.
Medical clinics are often the targets of fraud investigations. This is because the alleged fraud often involves a very high volume of billing. Anyone involved may be charged: doctors, nurses, dentists, physician assistants, clinic directors and even patients. Several people may be charged. Each should have their own Des Moines white collar crime lawyer. Co-workers can be turned against each other by plea deals.
Penalties for Defrauding Medicare and Medicaid in Polk County
The penalties for Medicare and Medicaid fraud can be severe. Offenders may face federal criminal charges, including fines of up to $250,000 for individuals and $500,000 for organizations, as well as prison sentences of up to 10 years per count. Additional penalties may include restitution, exclusion from future participation in federal healthcare programs, and civil fines under the False Claims Act, which allows treble damages (triple the amount of actual losses). In many cases, healthcare professionals may also lose their licenses and professional certifications. However, fraud charges rarely come one at a time; usually, there are multiple counts. Medicare and Medicaid fraud charges are often accompanied with other charges, like forgery and mail or wire fraud. The penalties can rack up to decades in prison and hundreds of thousands of dollars.
Additionally, there are civil penalties, including fines. A person convicted of Medicare or Medicaid fraud is no longer eligible to bill the program for services. If you are a doctor, nurse, or other medical professional, you may face issues with your license or other forms of professional discipline.
Defenses To Health Care Fraud in Des Moines
Defenses to Medicare and Medicaid fraud often center around the issue of intent. Prosecutors must prove that the accused knowingly and willfully submitted false claims or engaged in fraudulent conduct. A common defense is lack of knowledge or mistake, especially in complex billing situations where administrative errors occur. Another possible defense is good faith reliance on accountants, billing staff, or third-party contractors. In some cases, the defense may argue insufficient evidence, or that any billing discrepancy was due to negligence rather than criminal intent. Experienced criminal defense attorneys work to challenge the government’s evidence, dispute the interpretation of billing codes, and negotiate reduced charges or civil settlements when appropriate.
In defending against Medicare and Medicaid fraud charges, several strategies may be employed depending on the circumstances of the case. One common defense is the lack of intent or the presence of an honest mistake. Because fraud requires a showing that the provider “knowingly and willfully” submitted false claims, errors like miskeyed billing codes, incorrect dates, or misunderstandings in documentation may be characterized as accidental rather than criminal. If these mistakes were promptly corrected upon discovery, the government may be persuaded to reduce or drop the charges. Another defense involves reliance on a robust internal compliance program. Providers who operate within established systems of oversight, such as credentialing protocols, billing audits, and coder training, may argue they reasonably believed their claims were accurate. This “good faith reliance” can undermine the prosecution’s claim that the provider acted with fraudulent intent.
Additionally, insufficient evidence or lack of proof is a critical defense. Prosecutors must establish all elements of fraud, including material falsehoods, financial benefit to the provider, and that the claims involved a federal healthcare program. Defense attorneys often challenge the validity of billing logs or coded medical records, pointing out inconsistencies or a lack of reliable documentation. If the government’s evidence is incomplete or relies heavily on hearsay, the case may fail to meet the burden of proof. Another strategy focuses on causation and harm: if the allegedly false claims did not result in financial loss to the Medicare or Medicaid programs, such as when reimbursements were due to administrative error or were later repaid, the defense can argue that no real fraud occurred.
Procedural defenses may also come into play, especially during the investigative phase. If law enforcement oversteps legal bounds—such as executing an unlawful search or exceeding the scope of a subpoena, any improperly obtained evidence can be suppressed, weakening the prosecution’s case significantly. Finally, voluntary disclosure can be a powerful shield. Under both Iowa Medicaid and federal rules, providers who identify billing discrepancies and self-report them can often avoid criminal prosecution. Programs like the Self-Disclosure Protocol promote transparency and allow attorneys to negotiate favorable settlements, often resolving issues without formal charges being filed.
Medicare and Medicaid Fraud Resources
Iowa Department of Inspections, Appeals, & Licensing – The State of Iowa’s Official Website to Learn about Medicaid and other Public assistance Fraud
2025 National Health Care Fraud Takedown – This article discusses a massive takedown of Health Care Fraud in 2025, totaling over 14 billion dollars. It discusses the various ways that complex, transnational health care fraud was performed.
Health Care Fraud Unit of the DOJ – Visit the DOJ’s health care fraud unit website, to learn more about how health care fraud crimes are investigated and prosecuted
McCarthy & Hamrock, P.C. | Polk County Medicaid Fraud Attorney
Medicaid and Medicare fraud charges are a serious, complicated matter. An experienced Des Moines Medicare and Medicaid fraud lawyer can make a significant difference in the result of your case. At McCarthy & Hamrock, P.C., you will find skilled criminal defense attorneys who can represent you on federal fraud charges involving Medicare and Medicaid. Call today at (515) 279-9700 to set up a free consultation.