Medicaid fraud in Maryland refers to knowingly and willfully submitting false claims or making false statements in connection with a state health plan. A Medicaid fraud investigation threatens your medical license, your freedom, and your livelihood.
Both the Maryland Attorney General's Medicaid Fraud Control Unit and the U.S. Department of Health and Human Services Office of Inspector General actively pursue healthcare fraud cases across the state, and investigations often run for months before the target learns they are under scrutiny.
Our Maryland Medicaid fraud lawyers at Seddiq Law defend healthcare providers, Medicaid fraud defense attorneys, and individuals facing state and federal fraud allegations. Call (301) 513-7832 for a confidential consultation.
How We Defend Medicaid Fraud Cases in Maryland
We bring over 48 years of combined criminal defense experience to healthcare fraud cases. Our attorneys, Mirriam Z. Seddiq and Justin Eisele, have handled hundreds of state and federal matters, and when you hire our firm, both attorneys work on your case.
Mirriam is admitted to practice in Maryland, New York, and the U.S. District Courts for the District of Maryland. Justin is licensed in Maryland, Washington D.C., and Arkansas, and has been recognized as a 2025 Top Lawyer in Montgomery County.
Where We Defend Healthcare Fraud Cases
Medicaid fraud cases frequently involve parallel state and federal proceedings. We practice in both systems and appear regularly in:
- Montgomery County Circuit Court and District Court
- U.S. District Court for the District of Maryland
- Courts across the D.C. metropolitan area, including Prince George's County, Howard County, and Baltimore
Recognizing the Warning Signs of an Investigation
Many Medicaid fraud investigations begin long before formal charges appear. Several warning signs indicate that you may already be under investigation:
- Receiving a subpoena for patient records or billing data from the Attorney General's office or a federal agency
- Learning that current or former employees have been contacted by investigators
- Receiving a target letter from the U.S. Attorney's office
- Noticing an audit or review initiated by a Medicaid managed care organization
If any of these situations apply to you, involve a healthcare fraud lawyer before responding. We work to protect your rights during the investigative stage, when early legal strategy may influence whether charges are ever filed. Call (301) 513-7832 to speak with us today.
What Conduct Does Maryland Consider Medicaid Fraud?
Maryland prosecutes Medicaid fraud underCriminal Law §§ 8-509 through 8-516. These statutes prohibit a person from knowingly and willfully defrauding or attempting to defraud a state health plan in connection with the delivery of or payment for a health care service. The most common allegations include:
- Billing for services or procedures that were never performed
- Upcoding, meaning billing for a more expensive service than the one actually provided
- Submitting claims for medically unnecessary treatments
- Paying or receiving kickbacks or referral fees in exchange for patient referrals to Medicaid-funded services
- Falsifying patient records to support fraudulent billing
Federal prosecutors may also bring charges under the federal False Claims Act, 31 U.S.C. § 3729, the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b, or the federal healthcare fraud statute, 18 U.S.C. § 1347. These federal laws apply whenever Medicaid funds are involved, regardless of where in Maryland the alleged conduct occurred.
What Are the Penalties for Medicaid Fraud in Maryland?
The penalties are severe at both the state and federal level. Under Maryland Criminal Law § 8-516, a person convicted of Medicaid fraud involving $1,000 or more faces up to 5 years in prison and a fine of up to $100,000. Other violations of the Medicaid fraud statutes carry up to 3 years in prison and a fine of up to $50,000.
Federal Penalties and Civil Exposure
Federal healthcare fraud under 18 U.S.C. § 1347 carries up to 10 years in prison for each offense. If the fraud results in serious bodily injury to a patient, the maximum increases to 20 years.
On the civil side, Maryland's False Health Claims Act, Health-General § 2-602, imposes civil penalties of up to $10,000 per false claim plus treble damages, meaning three times the amount the state lost. The federal False Claims Act carries civil penalties ranging from approximately $14,308 to $28,619 per false claim, adjusted annually for inflation, plus treble damages.
Professional and Career Consequences
A conviction or civil judgment for Medicaid fraud typically results in exclusion from Medicare, Medicaid, and other federal healthcare programs. For healthcare providers, that exclusion often ends the ability to practice.
State licensing boards in Maryland also take action against providers convicted of fraud, which may include suspension or revocation of a medical license. The professional fallout from a Medicaid fraud case frequently outlasts any prison sentence.
What Defenses Apply to Maryland Medicaid Fraud Cases?
Not every billing error is fraud. Both Maryland and federal law require proof that the defendant acted knowingly and willfully, and that standard creates meaningful room for defense. A Medicaid fraud defense attorney in Maryland may pursue several strategies depending on the facts:
- Demonstrating that billing errors resulted from clerical mistakes, software issues, or ambiguous coding guidelines rather than intentional fraud
- Challenging the government's interpretation of medical necessity for the services provided
- Showing that the defendant relied in good faith on advice from billing staff, compliance officers, or legal counsel
- Contesting the accuracy of the government's damage calculations
- Raising constitutional challenges to the search warrants, subpoenas, or investigative methods used to gather evidence
The line between a billing dispute and a criminal prosecution often depends on whether the government proves intent. A Maryland Medicaid fraud lawyer who understands healthcare billing systems may identify weaknesses in the prosecution's case that change the outcome.
Ask Seddiq Law
I received a subpoena for patient records from the Attorney General's office. Do I need a lawyer?
Yes. A records subpoena from the Maryland Attorney General's Medicaid Fraud Control Unit signals an active investigation. How you respond, what you produce, and what you say during this stage may directly shape whether the investigation leads to charges. Involve a Maryland Medicaid fraud lawyer before producing any records or making any statements.
What is the difference between a state and federal Medicaid fraud case?
State cases fall under Maryland Criminal Law §§ 8-509 through 8-516 and the Attorney General's office prosecutes them. Federal cases involve the U.S. Attorney's office and agencies like the OIG and FBI, with charges under statutes like 18 U.S.C. § 1347. Federal cases often carry higher penalties and a broader scope of investigation.
Does a Medicaid fraud investigation always lead to criminal charges?
No. Many investigations end in civil settlements, administrative actions, or voluntary repayment agreements without criminal prosecution. However, the investigation itself is serious, and the choices you make during it, including what you say and what records you produce, may determine whether the case stays civil or becomes criminal.
FAQs for Maryland Medicaid Fraud Lawyers
How long do Medicaid fraud investigations take in Maryland?
Investigations often last months or even years before the target learns about them. The government typically reviews billing records, interviews witnesses, and builds its case before issuing subpoenas or filing charges. Early legal involvement during the investigative stage gives your defense team the best opportunity to respond strategically.
What is the Maryland False Health Claims Act?
The Maryland False Health Claims Act, Health-General § 2-602, creates civil liability for anyone who knowingly submits false claims to a state health plan. Penalties include up to $10,000 per false claim and treble damages. The Act also includes a qui tam provision that allows private citizens to file lawsuits on behalf of the state and receive a portion of any recovery.
What if I accidentally overbilled Medicaid but did not intend to commit fraud?
Intent matters. Both Maryland and federal law require proof that the defendant acted knowingly and willfully. Honest billing mistakes, software errors, and misunderstandings of complex coding rules are not fraud. Your attorney may present evidence of good-faith billing practices, compliance efforts, and the absence of a pattern to challenge the government's claim of intent.
Contact Maryland Medicaid Fraud Lawyers at Seddiq Law Now
A Medicaid fraud allegation puts everything you have built at risk, and the government has already been building its case long before you hear about it. The earlier you involve a defense attorney, the more options remain available. Seddiq Law answers the phone 24 hours a day. Call (301) 513-7832 to start building your defense today.