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.
Lack of Intent/Honest Mistake – Medicare and Medicaid fraud require proof that the provider “knowingly and willfully” submitted false claims. A common defense asserts billing errors were simple mistakes—such as a miskeyed code or misplaced date, not deliberate attempts to defraud. If the error was corrected promptly upon discovery, prosecutors may agree to drop or reduce charges.
Reliance on Compliance Program – Many healthcare providers maintain internal compliance systems, including credentialing protocols, regular billing audits, and coded training. A provider who operated under a robust compliance program may argue they reasonably believed claims were accurate and lawful. This “good faith reliance” can negate the intent element necessary for fraud, limits prosecutors’ ability to argue the provider acted with awareness to defraud the system
Insufficient Evidence or Proof – Prosecutors must demonstrate each element of the offense, including that false statements were material, that billing occurred within a federal program, and that the provider benefitted financially. Defense attorneys scrutinize alleged evidence, like coded records or billing logs, for inconsistencies. If key documents are missing, incomplete, or based on hearsay, the government’s case may crumble .
Lack of Causation/No Loss – Defenses may involve proving that the alleged false billing did not cause actual harm to the Medicare or Medicaid programs. For instance, if the insurance agency reimbursed a claim due to administrative oversight rather than false documentation, or if repayments were made, the defense can argue no tangible harm occurred, undermining the government’s argument that fraud occurred.
Procedural Defenses to Investigations – Investigations often involve extensive document subpoena and search warrants. Sometimes, federal agents make procedural mistakes, such as conducting an illegal search or collecting data beyond the scope of the warrant. If evidence is obtained improperly, it may be suppressed and thus excluded at trial, potentially derailing government cases
Voluntary Disclosure and Self-Reporting – Under Iowa Medicaid rules and federal law, providers who discover potential overbilling or misuse may voluntarily self-report and refund the government. This action can protect against criminal prosecution. Programs like the Self-Disclosure Protocol encourage providers to come forward, assist an attorney in negotiating settlements, and reduce the likelihood of damaging criminal charges.
Medicare and Medicaid Fraud Resources
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.