Fraud Investigations: Avoid Being Next

Fraud Investigations: Avoid Being Next

Anyone in the medical field can be charged with healthcare fraud. From nurses to doctors, and hospitals to pharmacists, there is a variety of parties who contribute to the high costs of medical care. As a result, fraud continues to be a hot topic in the healthcare community.

In recent years, there have been several headlines pertaining to Medicare, Medicaid, and private insurance companies conducting investigations into providers who engage in improper billing practices. Accusations of fraud can stem from both audits and whistleblowers, which makes it increasingly difficult for providers to hide behind fraudulent billing activities. Given the dramatic increase in investigations across the nation, it is extremely important for providers to be alert and comply with the law.

Billing Schemes Surrounding Healthcare Providers

It is all too common to see numerous investigative reports pop up surrounding medical professionals engaging in billing schemes. These crimes include billing for services that are not rendered, billing for non-covered services as a covered service, and the act of misrepresenting time, location, and providers. Some of the most common billing errors that result in charges include:

Double Billing: When medical providers bill both government programs and private insurance companies for the same services and supplies provided to patients, it can result in double billing.

Unbundling: There are instances where medical providers will bill for services separately when they should be billed as a bundled package. This term also applies to situations where doctors claim services provided during a single visit were actually provided on a different date. Doing so can cause the amount paid to increase.

Billing for Ineligible Practitioners: Medicaid and Medicare will only reimburse services provided by licensed and certified medical professionals. If the provider does not have the proper credentials, or they are on an exclusion list at the time services were rendered, they could be charged with filing a false claim. It is crucial to make sure all claims are accurately and timely filed to avoid this error and to make sure all licenses and certificates are current.

Prescription Fraud: Medical professionals can be charged with prescription fraud if they knowingly alter, write, obtain, or fill prescriptions for drugs that are not medically necessary. Although these charges commonly surround opioids and narcotics, the same rules apply to all drugs. It is crucial to maintain detailed records that show why these medications are necessary.

Errors in log files can appear to be billing fraud, especially if these instances occur regularly. It is crucial to ensure your billing records are accurate and up to date at all times.

Healthcare Fraud Group Can Help You

If you are dealing with criminal charges related to healthcare fraud, it is imperative that you reach out to a skilled and reputable healthcare fraud defense attorney as soon as possible. We at Healthcare Fraud Group have decades of experience fighting on behalf of doctors, nurses, and various other medical professionals to ensure they are not left to deal with the devastating consequences of a wrongful conviction. Contact our law firm today at 888-402-4054 to discuss legal options available for you.

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