Colorado Medicare Fraud Defense Lawyer

If you’re a healthcare provider in Colorado who bills Medicare, you are already prepared to handle complicated government regulations. What you may not be prepared for, however, is a letter from the Centers for Medicare & Medicaid Services (CMS) or when an investigator from the Office of Inspector General (OIG) comes knocking at your door. The white collar crime lawyers at Evergreen Attorneys are here to help. 

Colorado Medicare fraud investigations are on the rise, and with the Department of Justice cracking down on healthcare fraud in 2025, we have seen an increased need for the help of trusted Colorado Medicare fraud defense attorneys. Our team at Evergreen Attorneys has a deep understanding of the complexities that arise in Medicare fraud cases.

The Medicare fraud team at Evergreen Attorneys are ready to guide you through any subpoenas, audits, or federal agents at your door amidst Medicare fraud accusations you may be facing. In a climate where one misunderstanding may spiral into a federal case, we are ready to provide skilled legal advocacy.

What Makes Medicare Fraud Different From Other Fraud Cases

Medicare fraud, while falling under the blanket of white-collar crime, has unique characteristics that set apart cases from other fraud-related offenses. Colorado Medicare investigations can be led by both state and federal agencies. These cases often involve parallel proceedings, meaning you could face both civil penalties and criminal charges at the same time. Cases may target individual practitioners, private companies, state-run programs, or even patients. These cases are often pursued aggressively by prosecutors because of the direct harm to beneficiaries, whether through medical identity theft or compromised medical records. Colorado Medicare regulations are exceptionally complex, proving it necessary to have a detail-oriented defense attorney by your side if you are facing fraud charges.

Evergreen Attorneys are battle-tested and ready to help you defend against claims of Medicare fraud.

Common Situations That Lead to Medicare Fraud Allegations

Medicare is complex. You don’t have to be intentionally committing fraud to get caught in a medicare investigation. Many of those under fire are often targeted due to a mistake in billing or an overlooked employee issue. Common scenarios include:

• Billing for services not provided
• Providing services Medicare claims were “not medically necessary”
• Using incorrect billing codes
• Eligibility errors
• Questions about referral arrangements

While a number of these may be honest mistakes from provides, they can easily be articulated by prosecutors as misleading marketing, billing fraud, ambulance services fraud, medical equipment scams, and other violations that may be detrimental to your professional practice and your reputation.

Agencies and Statutes Involved

Due to their complexity, Colorado Medicare fraud offenses can be prosecuted by a number of agencies under both federal and state laws. Federally, Medicare fraud can be charged under:

• US Code 18 U.S.C. § 1347,
• the False Claims Act (FCA),
• the Anti-Kickback Statute, and 
• the Stark Law.

Agencies that may investigate include:

• Centers for Medicare & Medicaid Services (CMS)
• Office of Inspector General (OIG)
• Department of Justice (DOJ)
• Federal Bureau of Investigation (FBI)
• Colorado Medicaid Fraud, Abuse & Neglect Unit (MFANU)

What to Do If You’re Under Investigation for Colorado Medicare Fraud

If you’re a provider in Colorado and someone from CMS, OIG, or another agency reaches out about your Medicare billing or other practices, you can protect yourself. Most importantly, do not answer investigator questions without an attorney present. Even “casual” conversations can be used against you. Preserve all relevant documents and emails, including billing records, patient charts, and staff documentations. Do not alter or “clean up” records. Making changes after you become aware of an investigation can cause serious legal troubler later down the line. Obtain a lawyer who understands both the local healthcare landscape and the federal system. If you follow these practices, you will have safeguards that may protect you from serious Medicare fraud charges.

Why Local, Federal-Capable Representation Matters

Medicare fraud is a federal matter, so your defense lawyer should have experience with federal cases. But, local knowledge still matters, because Medicare fraud can have parallel proceedings investigated by both state and federal agencies. When it comes to understanding Colorado’s healthcare market, local representation will have a familiarity with Colorado medical providers, Colorado’s Medicare practices, and how federal agencies operate within the state.

If you’re facing questions about your Medicare billing, or if you believe you may be the target of a Colorado Medicare fraud investigation, the most important thing you can do is act proactively. Hire an attorney who will guid you throughout the entirety of your case. At Evergreen Attorneys, we defend providers across Colorado against medicare fraud allegations, guiding them through every step.

Call (303) 948-1489 or email [email protected] today to discuss your situation.