We Defend Clients In Any Fraud Enforcement Issue
Health care fraud is among the biggest threats facing the health care service industry. It’s estimated that it costs the U.S. government and the American people more than $100 billion annually. Federal and state agencies are very serious about combating health care fraud, and investigations and prosecutions have become much more aggressive in recent years.
Forget about a conviction. Even an investigation can ruin you professionally and financially. In such a situation, we can help clear your name. We build a customized defense based on the facts of the case and aggressively advocate for you the entire way.
What Regulators Are Looking For
Since many cases of fraud occur with the involvement of health care service providers, any suspicious activity on your part can bring you under the scrutiny of law enforcement agencies:
- Billing for services not provided: This involves billing Medicare for a service the patient did not receive. This includes forging the signature of a patient and giving kickbacks to corrupt Medicare officials.
- Upcoding of lower-cost services: This involves billing Medicare for services that are costlier than the procedures performed.
- Upcoding of lower-cost items: This involves billing Medicare for items that are costlier than those used or provided to the patient.
- Making duplicate claims: This involves changing some portions of a previously submitted bill (such as the date) that to Medicare and submitting it again to be paid twice for the same service provided.
- Unbundling of bills: Health care services normally cost less when bundled together. But a clever health care service provider can get a higher payout by manipulating the claims and staggering the bills over time.
- Billing for excessive services: This involves billing Medicare for services and equipment that were of a higher level than required.
- Billing for unnecessary services: This involves billing Medicare for services that don’t apply to the patients’ condition, such as an MRI for a patient with a sprained wrist.
- Receiving kickbacks: The anti-kickback statute prohibits physicians from receiving any form of compensation when making referrals or purchasing medical equipment, facilities, services or any other items covered by Medicare or Medicaid. Violation of the anti-kickback statute is punishable by a fine of up to $25,000 and a five-year prison term.
Health care fraud is a serious crime with severe penalties for the offender. Sometimes, violations can occur without your knowledge, such as a billing error. It’s best to put systems in place to audit your organization to find errors before they cause serious problems. If authorities discover a violation, either through a routine audit or an investigation, contact us immediately.
Advocates For Your Business And For You
Our firm serves clients from Dallas, across Texas, and nationwide. We can offer you a variety of health care legal services and defend you against any health care enforcement. Contact us by phone at 945-218-2698 or use this online form to schedule a meeting with a member of our team.