Medicare and Medicaid Fraud Lawyer in St. Louis

Medicare and Medicaid Fraud Lawyer in St. Louis, MO

When you're under investigation or facing charges for Medicare or Medicaid fraud in St. Louis or anywhere else in Missouri, your future and your reputation is on the line. These cases often trigger federal scrutiny, involve complex healthcare regulations, and carry the potential for enormous financial penalties and long-term imprisonment. At Combs Waterkotte, our St. Louis Medicare and Medicaid fraud lawyers understand what’s at stake—and we know how to fight back.

Whether you are a physician, pharmacist, nursing home operator, medical billing specialist, healthcare provider, or individual, being accused of government healthcare fraud can threaten your license, livelihood, and freedom. Let us step in and take control of the narrative.

Understanding Medicare and Medicaid Fraud in St. Louis

Medicare and Medicaid fraud refers to intentionally deceiving the federal government for unlawful gain through the Medicare or Medicaid programs. These fraud allegations are taken seriously by the Department of Justice (DOJ), the Office of Inspector General (OIG), and the Centers for Medicare & Medicaid Services (CMS).

Common examples of Medicare and Medicaid fraud include:

• Billing for services not rendered
• Upcoding or inflating billing codes
• Unbundling services to increase payment
• Performing unnecessary medical procedures
• Accepting or giving kickbacks for referrals
• Falsifying patient records or diagnoses
• Using stolen provider credentials
• Overuse of services
• Overuse of equipment

These offenses can trigger both criminal and civil investigations, including audits, subpoenas, and aggressive enforcement actions. Don’t face this alone—our St. Louis Medicare and Medicaid fraud attorneys know how these agencies work and how to challenge their allegations effectively.

What Are the Penalties for Medicare or Medicaid Fraud in St. Louis, MO?

The federal government can prosecute health care fraud under several laws, including the False Claims Act (U.S.C. §§ 3729-3733), Anti-Kickback Statute (42 U.S.C. § 1320a-7b), and Health Care Fraud Statute (18 U.S.C. § 1347). Depending on the scope and intent of the fraud, consequences may include:

• Up to 10 years in federal prison per offense
• Up to 20 years if serious bodily injury occurred
• Loss of professional licenses or certifications
• Federal program exclusion or disqualification
• Damage to your personal and business reputation
• Civil penalties of $11,000+ per false claim
• Treble damages (three times the billed amount)

A skilled Medicare and Medicaid fraud defense lawyer can help you avoid the worst-case scenario, protect your license, and seek case dismissal, charge reduction, or favorable resolution.

Who Is Targeted in St. Louis, MO Medicare and Medicaid Fraud Investigations?

Federal investigators may focus on anyone involved in the billing or provision of medical services. This includes:

• Doctors and nurse practitioners
• Physical therapists and chiropractors
• Mental health professionals
• Medical office managers and billing staff
• Pharmacists and home health agencies
• Medical equipment companies

Being targeted in an investigation doesn’t mean you’re guilty—but it does mean you need experienced legal protection immediately. Our St. Louis fraud attorneys know how to challenge search warrants, subpoena scope, patient records audits, and financial analyses that could be used against you.

How We Defend Medicare and Medicaid Fraud Charges in St. Louis, MO

At Combs Waterkotte, our legal defense always starts with a deep dive into the evidence. From there, we customize a defense plan that may include:

• Challenging the accuracy of billing or coding audits
• Arguing lack of intent to defraud
• Demonstrating compliance efforts and good-faith practices
• Attacking the credibility of government witnesses
• Negotiating settlements that avoid prosecution
• Securing dismissals or acquittals at trial

We’ve successfully represented health care professionals in complex fraud cases in St. Louis and across Missouri, and understand both the medicine and the law behind these accusations.

Strategic Defenses Against Medicare and Medicaid Fraud Charges in St. Louis, MO

Being accused of healthcare fraud in Missouri doesn’t mean you’re guilty. At Combs Waterkotte, we explore every possible avenue to protect your rights and dismantle the government’s case. Some of the most effective legal defenses we use include:

• No Criminal Intent: Fraud requires a deliberate intent to deceive. If your actions were the result of honest mistakes, clerical errors, or billing confusion, you can’t be convicted. Misunderstandings don’t equal fraud.
• Weak or Inconclusive Evidence: The prosecution must prove beyond a reasonable doubt that you knowingly committed fraud. If they lack documentation, testimony, or reliable records, their case falls apart.
• Established Compliance Protocols: If your practice or business had strong internal compliance procedures, it can serve as proof that you acted in good faith, not with criminal intent. We use this to your advantage in court or negotiations.
• Authorization or Consent: If you were explicitly given permission to carry out the action in question, like through patient consent or administrative direction, that can serve as a legitimate defense.

Why Choose Combs Waterkotte for Health Care Fraud Defense in St. Louis, MO?

Medicare and Medicaid fraud cases are prosecuted in federal court with sophisticated investigators, forensic accountants, and expert witnesses. You need a law firm that knows how to match that firepower. Our clients appreciate our fierce advocacy, tireless work ethic, and unwavering commitment to their future. When the government brings a case, we bring the defense. Combs Waterkotte has:

• Over 50 years of combined trial experience
• Former prosecutors who know the government’s tactics
• Direct access to defense attorneys—not junior staff
• 24/7 availability and full transparency
• A track record of dismissals, acquittals, and reduced charges
• Strong relationships with forensic and compliance experts