Medicare Fraud Defense Lawyer

Medicare Fraud Defense Lawyers

Have you recently been accused of Medicare fraud? 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 result in your case being dismissed altogether.

If you’re found to have committed Medicare fraud, you may be subject to hefty fines and other liabilities or disciplinary actions. In some of the worst cases, physicians have been incarcerated or had their licenses revoked. If you’re being investigated for fraud schemes involving Medicare, Medicaid, or Tricare, it would be wise to invest your time and money in our Medicare fraud defense lawyers at the Healthcare Fraud Group.


Hire Our Experienced Medicare Fraud Attorneys

Our team of skilled medicare fraud attorneys hve worked with countless physicians and other health care professionals in similar situations. Our team understands that this is a very stressful time that can have a lasting effect on your career. We also know that you have worked hard to earn your medical degree and acquire your license to practice. Therefore, 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 marketers, and laboratory personnel. 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 such as clerical errors to major infractions such as fraudulent billing.

Medicare fraud involves submitting a false claim to one of the government’s health care programs. The government takes these allegations very seriously because they cost the taxpayers a lot of money. Statistics determine that Medicare claims that are in excess of $50 billion per year are potentially suspicious and need to be investigated. If you operate a busy and successful practice that submits high volumes of Medicare claims, it is likely that at some point you will be subjected to an investigation. If you are an employee of a hospital or other healthcare organization you may have already encountered some of these fraudulent activities:

  • 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 patients. There are other cases where doctors continue to bill for treatment for a deceased patient.
  • 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 required. 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 specialized treatments. This could result in the worsening of a patient’s condition.
  • Unbundling – Unbundling is another example of health care fraud when doctors bill for treatments separately when they should have been combined into one bill. Medicare groups certain standard procedures together so that they are more affordable for the customer. Some dishonest doctors may bill for these treatments separately in order 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. The government will not allow pharmaceutical companies to bribe physicians into prescribing medication to patients. Also, laboratories are not permitted to pay commissions for every patient sent in for blood tests.
  • 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, it means that you have exaggerated the treatment that was given to a patient. In some cases doctors have billed for a more expensive service then the patient received. An example of this is if a doctor billed 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 withstood vigorous testing for safety and effectiveness. Doctors and pharmaceutical companies are not allowed to market, promote, sell, or prescribe medications for purposes other than those stated by the FDA.

Actions That Could Result In Guilt

Physicians and other health care professionals who have been found guilty may be exposed to recoupment requests; this is when the government requests that you pay back any legal fees and expenses that they have incurred as a result of their investigation.

You may also receive civil fines 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 ordered to pay triple damages, as well as attorney fees and criminal fines. It’s crucial to call on our team of Medicare fraud defense lawyers as soon as possible. We will work to limit the financial impact and hopefully avoid a personally an professionally detrimental guilty verdict.

The worst-case scenario would be criminal indictment, license revocation, and incarceration. Physicians can be found 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 knowingly submitted a fraudulent transaction. For this reason, many physicians and health care organizations are penalized for innocent mistakes made by their employees.


Who Investigates Medicare fraud?

The main organizations that investigate Medicare fraud and fraud against the government’s health care programs are:

  • The Office of the Inspector General (OIG)
  • The Department for Health and Human Services (HHS)
  • The 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 U.S. health care system? If you suspect that your employer is guilty of carrying out some form of health care fraud, you may feel threatened and compelled to ac t. You likely don’t know if the deception was intentional or not. Our lawyers can provide support and advice to help you to move forward with reporting your observations 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 fast since lives could be in danger. We have helped health care professionals who have had information about their employers that could have resulted in investigation into their business practices. In some cases, you may have already been fired or demoted for having certain information, or for asking too many questions. We can help prepare your case and defend you so that your career is salvaged. In some cases, you may even receive financial compensation if you have been unfairly removed 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 must be the original source of the information. The information must also 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 attorneys 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:

1. The False Claims Act
The False Claims Act was set up to stop physicians from submitting false or fraudulent claims, whether knowingly or unknowingly, to health care benefit programs. These programs include Medicare, Medicaid, and 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 by the government or as the 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, in order 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 in your organization has been negligent or made an innocent error, it is not enough to hold you liable under the False Claims Act.

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 established to monitor doctors and their relationship with 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, including one in which the immediate family of a physician financially benefited from a referral. We can help you too.

3. Anti-Kickback Statute
This law prohibits the swapping of goods and services for a business opportunity that Medicare, Tricare, or 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 accidentally caught up by the Anti-Kickback Statute. Physicians may be unexpectedly investigated if they have been illegally referring patients; the definition of a “referral” within the Anti-Kickback Statute is broader than many health care professionals realize.

We recently worked on a case in which a mutually beneficial financial arrangement had been made between a doctor and a physiotherapy center. This arrangement was illegal since 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 prevent physicians from knowingly filing false claims in order to receive money from a government-supported healthcare program. Being found guilty under this statute could result in up to ten years in prison.

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 you’re found guilty, or exclude your organization from their programs. To be issued a civil monetary penalty, a doctor must have knowingly submitted a claim for an item or service that was false, fraudulent, or was 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. 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 programs 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 due to felony convictions such as unlawfully manufacturing, distributing, and prescribing controlled substances. This is most commonly a result of prescribing opioid medications in excess or unnecessarily. Physicians who have been excluded can no longer bill directly for patient treatments using Medicare. They also won’t be able to bill their services indirectly through an employer or practice.


How Can Our Professional Medicare Fraud Defense Lawyers Help You?

Our team of experienced and knowledgeable Medicare fraud defense attorneys will work together to ensure the best possible outcome. We will concentrate on defending you and your business or practice against the five most common laws used to hold physicians liable.

We have a proven track record of successfully representing doctors, surgeons, nurses, and other health care professionals against allegations made against them. Doctors are considered pillars of the community and we can help protect your reputation. Our team has gained extensive industry knowledge over the years and understands the Medicare system. We also have a deep 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 and 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 result in your case being dismissed.

Our team is also well versed in dealing with a variety of government agencies. We understand the policies that have been put in place by these agencies. There is often a very fine line between liability and innocent human error. Despite this, we will be able to present a solid argument on your behalf. Our team has excellent negotiation skills and impeccable attention to legal detail.

We have extensive knowledge and experience in dealing with all fraud allegations or investigations within the health care industry.


Contact Our Experienced Medicare Fraud Attorneys Today!

If you and your team are being investigated for Medicare or any other kind of 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 during which we will advise you on the next steps.

Your case will be handled professionally and confidently. We aim to offer as much help and support as possible in order 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 and we may even be able to get your case dismissed altogether.