Medicare Fraud Attorney Santa Rosa CA
Have you recently been accused of Medicare fraud in Santa Rosa? Perhaps you’re under investigation for a discrepancy such as phantom billing or up-coding. Are you being accused of billing for services that are considered medically unnecessary? If so, it’s essential to act fast.
We have a professional and experienced team of Medicare fraud lawyers who are knowledgeable about medical matters and are here to help defend against any allegations made against you. Our attorneys will work hard to plan a strategic defense. This will limit the impact that the allegations could have on your career and in some cases, could even get your case dismissed altogether.
If you’re found to have committed Medicare fraud, you may be subject to hefty fines and other liabilities or disciplinary action. In some of the worst cases, physicians have even been incarcerated or had their licenses revoked. If you’re being investigated for fraud that involves schemes such as Medicare, Medicaid, and Tricare, it would be wise to invest your time and money in our Medicare fraud defense lawyers at the Healthcare Fraud Group today.
Hire Our Experienced Medicare Fraud Attorneys In Santa Rosa
Our team of skilled medicare fraud attorneys has worked with countless physicians and other health care professionals in similar situations over the years. Our team understands that this is a very stressful time that can have a lasting effect on the career. We also know that you have worked hard to achieve acquire your medical degree and license. We want to help protect you against any allegations that have been made against you. We have a proven track record of successfully defending doctors and other health care professionals, such as pharmacists, health care marketing companies, and laboratories with their legal needs. We will work hard to help you protect your reputation and your career.
Examples of Medicare Fraud
Let’s look at some of the different reasons that you may have been accused of Medicare fraud. These claims can vary in severity from minor infractions, which were made innocently to more serious allegations in which the physician knowingly billed for treatments a patient did not receive.
Medicare fraud involves submitting a false claim to one of the government’s health care programs. The government takes these allegations very seriously as they cost the taxpayer a lot of money. Statistics show that Medicare claims that are in excess of $50 billion per year are considered suspicious and need to be investigated. If you have a busy and successful practice that submits high volumes of Medicare claims, it’s likely that at some point, you will be subjected to an investigation. If a hospital or health care practice employs you, you may have come across some of these types of fraudulent activities in Santa Rosa:
- Phantom Billing – Phantom billing is the most common type of Medicare fraud. This type of fraud occurs when a health care professional bills Medicare for a treatment that was never performed. Another example would be if a dentist billed for full dental plates when the patient only received partial dentures. Our firm has witnessed cases where phantom bills were created for patients who had moved away and were no longer a patient at the clinic. There are other cases where a doctor continued to bill for treatment for a patient who has died.
- Falsification of Patient Records – Doctors may falsify a patient’s medical record in an effort to receive payment for treatments that were medically unnecessary. They may ask for tests or examinations to be carried out that aren’t needed. In more severe cases, doctors may have convinced a patient that they are suffering from a specific ailment so they can bill for surgeries, medication, or treatments. This could result in a worsening health condition for the patient.
- Unbundling – Unbundling is another example of health care fraud; this is when doctors have billed for treatments separately when they should have been combined into one bill. Medicare groups specific standard procedures together so that they can be performed at a cheaper rate. Some dishonest doctors may bill for these separately to make more money.
- Double billing – A doctor can be investigated for fraud if they have billed Medicare, the patient, or the patient’s insurance company twice for the same medications or treatment.
- Kickback fraud – This is where a medical practitioner may have an agreement with laboratories, pharmaceutical companies, or clinics. They may be offered money, products, or services in exchange for referrals. This is, in fact, illegal. The government will not allow a pharmaceutical company to bribe physicians to prescribe its medication to patients. Also, a laboratory can not pay commission for every patient the physician sends in for blood tests. If this were prohibited, it would result in a lot of unnecessary tests or treatments being carried out.
- Self-Referrals by Doctors – Similarly, doctors are not able to refer patients to clinics or service providers that the doctor has a financial interest in. Example: If a doctor’s wife or child runs a health care company, the doctor can’t refer patients there.
- Upcoding – If you are being investigated for upcoding, this means that you have exaggerated the treatment that was given to the patient. In some cases, doctors have billed for a more expensive service then the patient received. An example of this is if a doctor bill for a one-hour consultation when the patient’s visit only lasted ten minutes.
- Falsification of Cost Reports – Health care providers will be investigated for fraud if they have included personal expenses in their Medicare claims.
- Marketing Pharmaceuticals as Off-Label – The FDA (Food and Drug Administration) approves drugs only after they have carried out vigorous testing for safety and proved that they are safe and effective. Then that drug is only recommended for a specific use. Doctors and Pharmaceutical companies are not allowed to market, promote, sell, or prescribe a medication for a different purpose.
Actions That Could Result In a Guilt
Physicians and other health care professionals who have been found guilty may be exposed to recoupment requests. This is where the government requests that you pay back any legal fees and expenses that they have incurred as a result of their investigation.
On top of this, you may receive civil fines, which can be as high as $11,000 per false claim. A guilty verdict could also mean that your practice will be excluded from federal health care programs in the future.
In other cases, we have seen physicians being asked to pay treble damages, as well as attorney fees and criminal fines. It’s crucial to call in our team of Medicare fraud defense lawyers as soon as possible. We will work to limit the financial impact and hopefully avoid a guilty verdict that can have detrimental effects on your business.
The worst-case scenario would be that a doctor is served with a criminal indictment, has their license revoked, and is unable to practice medicine or may even be subjected to incarceration. Physicians can be deemed guilty and held liable for Medicare fraud whether or not they intended to break the law. The government does not have to prove that the accused doctor or health care profession knowingly submitted a fraudulent transaction. For this reason, many physicians and health care organizations are penalized for a mistake that was made innocently by employees who they have employed.
Who Investigates Medicare fraud?
The main organizations that investigate Medicare fraud and fraud against the government’s health care programs are as follows:
- The Office of Inspector General (OIG)
- The Department for Health and Human Services (HHS)
- Department of Justice (DOJ)
- The Federal Bureau of Investigation (FBI)
- Medicaid Fraud Control Units (MFCUs)
- State Medicaid Agencies
- The Health Care Fraud Prevention and Enforcement Action Team (HEAT)
- The General Services Administration (GSA)
- The Centre for Medicare and Medicaid Services (CMS)
What To Do If You Suspect Your Employers of Medicare Fraud?
Are you a doctor or nurse working in the American health care system? If you suspect that your employer is guilty of carrying out some form of health care fraud, then you may feel that you are in a compromising situation. You probably don’t know if the deception was intentional or not. Our lawyers can provide support and advice and help you to move forward with reporting what you have witnessed to the relevant departments.
If you know that your employer is overcharging Medicare, by applying improper coding claims or carrying out unnecessary treatments, it’s important to act straight away as lives could be put in danger. We have helped health care professionals who have information about their employer that would result in an investigation into their business practices. You may have already been unfairly fired or demoted due to the information you have or for asking too many questions. We can help prepare your case and defend you so that your career isn’t ended. In some cases, you may even receive financial compensation if you have been unfairly let go from your position.
Employees, patents, and the general public can report medicare or health care fraud to the government by visiting the stop Medicare fraud website. This is a joint site that is run by the Department of Justice (DOJ) and the Department of Health and Human Services (DHHS).
If you have evidence of serious and ongoing healthcare fraud, whether or not it involves Medicare, you may be financially rewarded by filing a whistleblower lawsuit. To receive a pay-out, you would have to be the original source of the information. The information would also have to be new and unknown to the government or public at the time you report it. You also must not have played any part in committing the fraud, including planning or carrying out the fraudulent activity.
If you would like advice about preparing a whistleblower case, contact our professional health care fraud attorney today. We can help you through this complicated process.
Laws Used in Medicare Investigations
There are five primary laws that are used in Medicare investigations and they are listed below:
1. The False Claims Act
The False Claims Act was set up to stop physicians from submitting false or fraudulent claims, whether knowingly or not, to health care benefit programs. These programs include Medicare, Medicaid, or other government health care programs. Being investigated under the false claims act can lead to either civil or criminal charges.
Under this act, physicians may be subject to an investigation directly from the government or as a result of a referral. Your business may have been referred by a whistleblower who could be a current or former employee, patient, or competitor. The government offers compensation in exchange for information from whistleblowers.
A health care professional can be investigated under the false claims act for submitting a false claim, either intentionally or by accident. An example of this would be if a doctor filed a claim for a treatment that was more expensive than the one the patient actually received. However, to be considered a false claim and to be charged with health care fraud, you must have attempted to defraud the government. If an employee at your organization has been negligent or made an innocent error, under the false claims act, this is not enough to hold you liable.
2. The Stark Law
The Stark Law is often used to prosecute health care professionals. This is a federal law that applies to physician referrals; it prohibits “self-referrals” between doctors and other health care providers. It also makes it illegal for providers to bill Medicare for referred services.
The Stark Law was set up to be used on doctors and their relationship with the labs. Today it has been applied to all health care agencies, as well as federal prosecutors. The Stark Law is used in cases against pharmacists, therapists, and other health care providers.
We have handled cases involving The Stark Law, where the immediate family of a physician financially benefited from a referral and we can help you too.
3. Anti-Kickback Statute
This law prohibits the swapping of goods and services for a business opportunity that involves schemes such as Medicare, Tricare, and Medicaid. The Anti-Kickback Statute can be applied to all health care providers, businesses, and organizations who use these programs.
It’s common for doctors and other health care professionals to be caught up by the anti-kickback statute, unknowingly. Physicians in Santa Rosa may be unexpectedly investigated if they have been illegally referring patients. The problem is that the definition of a “referral” is broader than most providers realize in the anti-kickback statute.
We recently worked on a case where a financial arrangement had been made between a doctor and a physiotherapy center, which benefited both businesses. This arrangement was illegal as the government’s regulatory safe harbors did not cover it. The physiotherapy center had been offering cash and other benefits to the doctor in exchange for referrals.
4. Criminal Health Care Fraud Statute
The Criminal Health Care Statute makes it illegal for health care practitioners to defraud a healthcare benefit program, such as Medicare or Medicaid. It aims to stop physicians from knowingly making false claims to obtain money from a government-supported healthcare program. Being found guilty under this statute could result in up to ten years of incarceration.
5. The Civil Monetary Penalties Law
This law allows the Secretary of Health and Human Services to fine practitioners who are found guilty of carrying out any form of fraud or abuse that involves Medicare. They may also carry out ongoing assessments if found guilty or exclude your program from their programs.
To be issued with a civil monetary penalty, a doctor must have knowingly submitted a claim for an item or service that is false, fraudulent, or is not reimbursable by Medicare.
The government is allowed to charge up to $ 50,000 for each false claim that they find your practice guilty of submitting. Failure to follow the Medicare rules is likely to result in significant fines. The government may also charge remuneration of up to three times the amount offered, solicited, paid, or received.
The Exclusion Statute
There is also a law that could be used against you if you are found guilty of committing Medicare fraud in Santa Rosa. This is the exclusion statute. Physicians and health care companies or clinics who have been convicted of criminal offenses will be excluded from federal healthcare programs, including Medicare and Medicaid.
Doctors can be excluded from these schemes for several reasons, the most common being Medicare fraud or other offenses which involve the delivery of healthcare services. Physicians who have been found guilty of patient neglect or abuse or have been convicted of theft, fraud, or other financial misconduct, will also be excluded.
There have been cases where health care professionals are excluded because of felony convictions such as unlawfully manufacturing, distributing, and prescribing controlled substances. This is most commonly caused by prescribing opioid medications when they were in excess or unnecessary. Physicians who have been excluded can no longer bill directly for treatment to patients using Medicare. They won’t be able to bill their services indirectly through an employer or practice.
What Is the Statute of Limitations for Healthcare Fraud?
The Statute of Limitations is normally five years in criminal healthcare fraud investigations. Nevertheless, the 18 U.S.C. 3282 is subject to many exceptions that can extend the allowable prosecution phase, especially if the case is charged as a federal healthcare fraud conspiracy.
How Can Our Professional Medicare Fraud Defense Lawyers Help You?
Our team of experienced and knowledgeable Medicare fraud defense attorneys will work together to utilize our skills and experiences to ensure the best possible outcome for the charges you are facing. We will concentrate on defending you are your business or practice against the five most common laws used to hold physicians liable.
We have a proven track record of successfully representing numerous doctors, surgeons, nurses, and other health care professionals to defend against allegations made against them. Doctors are considered pillars of the community and we can help protect your reputation. Our team has gained industry knowledge over the years and understand the Medicare system. We have an intrinsic understanding of CMS (Centre for Medicare and Medicaid Services) protocols.
You need a lawyer who understands medical investigations and terminology. You need a lawyer who has experience in dealing with Medicare fraud claims. We understand coding policies and keep ourselves up to date with billing changes, as well as, coding violations.
Our team of health care fraud defense lawyers is well versed in dealing with Stark Law violations. We can help defend against charges brought against you and your business. We may even be able to find a safe harbor exception which could get your case dismissed.
Our team is also well versed in dealing with a variety of government agencies. We understand the policies which have been put in place. There is often a very fine line between liability and innocent human error. We are, therefore, able to put forward a solid argument on your behalf. Our team has excellent negotiation skills and apply attention to detail in every case.
We have extensive knowledge and experience in dealing with all fraud allegations or investigations in the health care industry.
Contact Our Experienced Santa Rosa Medicare Fraud Attorneys Today!
If you and your team are being subject to an investigation involving Medicare or any other health care fraud, it’s important to get representation as soon as possible. Contact our team of Medicare fraud lawyers today to discuss your situation. We offer a free no-obligation assessment where we will advise you on the next steps that need to be taken.
Your case will be handled professionally and confidently; we aim to offer as much help and support as possible to get you through this challenging and stressful time. Don’t hesitate, contact us today on by phone 888-402-4054 or email.
We will help to limit the impact of investigations made against you and in some cases, may even be able to get the case dismissed altogether.