Defense Against Healthcare Fraud: Medical Billing

Defense Against Healthcare Fraud: Medical Billing

Before representing a client accused of healthcare fraud, it is imperative for a defense team to gain knowledge of the details surrounding the case. In particular, defense attorneys should be well versed in Medicare billing as well as errors that may occur. Not having adequate knowledge surrounding Medicare, Medicaid, and private insurance billing can create problems for attorneys who desire to create a solid defense strategy.

Before Medicare, Medicaid, or private insurance companies are billed, the doctor or practice may be credentialed by the insurance company. These credentials certify that the practice or physician is committed to complying with federal rules and regulations as well as policies established by the providers themselves.

How Medical Codes Work

Medical coding is typically used for billing purposes. Every medical treatment, medical services, or medication comes with its own codes. The code can be different depending on the provider receiving the bill. Generally, there are three common types of codes used in billing. These codes include CPT codes, which are Current Procedural Terminology, Healthcare Common Procedures Coding System codes (HCPCS), and the third type is International Classification of Diseases.

The rules for Medicare are extremely complex. The Center for Medicare Services regulations determines what Medicare will reimburse. This is generally where problems occur. The government will indict doctors and practices for charging for services that were considered to be rendered in violation of the regulations established by the local and national coverage determinations (LCD and NCD) or for charging services that are not considered medically necessary.

Using the Proper Code

When requesting payment from insurance providers like Medicare and Medicaid, it is imperative to use the proper code for the procedure. Unfortunately, there are numerous instances where billing specialists send requests for payments using improper codes. Unfortunately, these actions can create a red flag in the system and prompt an investigation for billing code errors

There are numerous instances where coders send over the improper codes and get medical professionals in trouble. Investigations and other consequences of using improper billing codes can result in jail time, extreme fines, and the loss of licenses to practice. When doctors and other medical providers are accused of healthcare fraud due to medical billing problems, it is crucial that they reach out to an aggressive defense attorney as soon as possible.

Healthcare Fraud Group Is Here For You

If you or your practice was accused of healthcare fraud, it is imperative that you understand the potential consequences. A conviction can have a devastating impact on your ability to practice. It can result in jail time and extensive fines. It is crucial that you reach out to an aggressive healthcare fraud defense attorney who can help you protect your legal rights.

We at Healthcare Fraud Group have extensive experience helping medical professionals accused of fraud and other illegal acts get the justice they deserve. We provide adequate and effective defense strategies that help those accused have their charges dismissed or drastically reduced. Contact our team today at 888-402-4054 to get representation you can trust.


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