The state of health care in Kentucky and around the nation is a top concern of many Americans. The regulations governing Medicare and Medicaid can be baffling to both patients and practitioners. Failure to adhere to regulations, regardless of lack of intent, can lead to serious charges involving Medicare and Medicaid fraud.

A recent case involving a mental health counselor resulted in his receiving a possible 10-year jail sentence for overbilling Medicaid. The disputed amount is reportedly over $260,000. The gentleman had been a practitioner at the counseling center since 2007 and the amount in discrepancy included billing information from 2007 – 2019.

Medicaid only allows for 30-minute face-to-face sessions between a counselor and a client. The majority of the reimbursement submissions that the counselor submitted were reported to be for 45 to 60-minute sessions. These session times appear to account for the alleged overbilling amount that is in dispute.

Medical professionals focus on practicing their craft and facing charges of Medicare and Medicaid fraud can come as a shock and be very unsettling. Fear of losing a medical license and one’s livelihood can cause feelings of fear, anxiety and even panic. It is important to remember that anyone so accused is presumed innocent until and unless proven guilty in court. Consulting with an attorney experienced in dealing with Medicare and Medicaid fraud charges in Kentucky can provide the client with information regarding one’s rights and the legal options that are available. Facing such charges can cause a person to feel very alone, and it can be helpful to consult with someone who may be able to provide a path forward.