Legal Question in Health Care Law in Kentucky
This question is related to possible hearcare fraud/false claim/billing and business dispute.
The business seller sold a business whose revenue came from Medicaid. However the Medicaid billing claim that the business filed does not compliance with government Medicaid billing requirement. The business seller presented the earning number based on the above false billing and sold his business without disclosing the false billing fact. After the buyer bought the business and found the issue, he consulted the attorney general office(mostly deal with criminal fraud) and State Medicaid fraud control office. The answers are: Although the business seller made false billing, but the attorney general office will not likely to pursue the case as a criminal conduct because the seller's business actually provided Medicaid services even if the business did not comply Medicaid billing requirement . Technically the billing conduct was a fraud but not a typical criminal level fraud and the correction is mostly likely through educating the people involved. The State Medicaid fraud control office(mostly handle administration) considers this a fraud claim because the business should not have received any payment from Medicaid.The seller was also likely knowingly conduct the false claim giving he was in the business for 20 years. The seller may or may not be asked to payback the billed amount from Medicaid.
The seller's false billing may or may not causing damage to the government. The false billing damaged the business buyer who made business purchasing decision based on false claimed earning. Through legimate effort (i.e. to comply the billing regulation), the buyer cannot or extremely difficult to re-produce the earning the seller generated. The buyer wants to go court to charge the seller knowingly mislead the earning and conduct fraud/false claim billing to Medicaid. The goal is to recover the loss and ask the seller to take back the business at the price of being sold.
Question: How likely the buyer can win the case and get compensated. Does most lawyer not take dispute cases on contingency basis?
If a lawyer only charge on hourly rate, how can the buyer have confidence if the lawyer does not.
2 Answer from Attorneys
There is no way to assess your case without a full consultation and review of all documents in your case. You need to get a consult with an attorney who practices in this area. But fraud cases are tough: you have to prove intent. It sounds like those who investigated just thought these people didn't know what they were doing. Being dumb and being a fraud isn't the same. (If being dumb was a crime, there wouldn't be enough jail cells.) That's just my thought, that would be a tough hurdle to overcome.
Whether an attorney takes a case on contingency has less to do with the attorney's confidence in the case and more to do with the attorney's finances. Civil cases can take years to resolve, and fronting costs for experts, depositions, etc., isn't always feasible. Being a broke poverty law attorney myself, I take very few contingency fee cases, no matter how good the case may be. And no matter how good the case may be, there is no such thing as a sure thing.
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