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One of the most profitable crimes in America is Medicare fraud. Shockingly, it is costing taxpayers more than $60 billion every year. These types of cases are complex. The laws are constantly changing as is the regulations that govern Medicare. When a doctor or medical community comes under fire for Medicare fraud, they have an uphill battle. However, there are things that can be done to protect you and your reputation.
Hospitals and doctors over charge and bill erroneously by accident on a regular basis. It is difficult to keep all the patients and their charges in perfect order. Human error is to cite for the fault in many of these cases. In most instances, the charges are legitimate oversights. However, a continued pattern of false charges could indicate a problem. These oversights are sometimes fraudulently based. Such crimes can put you at the center of an heated investigation. There are laws to protect people you and lawyers who will fight for on your behalf.
Settling The Investigation
Medicare is an insurance program that is meant for people who are age 65 or older, or this program will cover those who have a disability under this age. A Medicare fraud case is expensive to litigate. Investigation costs can rack up to hundreds of thousands of dollars. However, when using a Dallas lawyer who knows all about these types of cases, we can cut out unnecessary expenses. Medicare’s rules and regulations are difficult to understand. However, understanding these regulations is the key to successfully disputing a healthcare fraud case. A Dallas Medicare fraud lawyer can mean the difference between winning or losing in a case like this. If you are being accused of abusing the Medicare system, you should speak to an attorney immediately. There are things we can do to help.
Common Types of Medicare Fraud
It is a highly technical process to prove Medicare fraud, and the burden of proof is on the prosecutor. There are rules that must be followed, and they must convince the judge or jury that you committed fraud. Fraud occurs when a person or company bills the government program for services that they never received or provided to a patient. Keep in mind there are many types of Medicare fraud. However, the goal is the same in each type of wrongdoing: bill erroneously to increase revenues. Here are some common types of Medicare fraud.
Double Billing: Double billing is a huge problem. Some medical facilities will charge twice for the exact same service.
Phantom Billing: A phantom billing occurs when a company charges for medical tests but do not preform those tests. Additionally, they can use employees’ names that do not exist to pull off this scheme.
Pharmaceutical Fraud: When one is guilty of pharmaceutical fraud, they will use kickbacks, price fixing, schemes like off-label marketing and others to increase their Medicare profits.
Upcoding: Upcoding occurs when a company uses CPT, Current Procedural Terminology, to bill with two or more codes. Medicare has strict laws about bundling claims together for processing. Using various CPT codes allows companies to charge more and get more money in return.
Not Proving Medical Necessity: For any service to be approved through Medicare the service must be medically necessary. Many doctors and organizations will do tests that are not necessary to inflate their bills.
Fighting The Charges Against You
Whistleblowers or random audits can expose billing issues within a doctor or medical facility billing. If you have defrauding the government for income, then you will need to make restitution for those erroneously billed amounts. These are federal crimes that can come with jail time, hefty fines, or both. Medicare is a great program that should be utilized appropriately. Remember, don’t fight this battle alone. There is security in a strong legal team. There are Dallas Medicare fraud attorneys who want to help. We will protect your rights each step of the way. Our knowledgeable staff knows what it takes to protect those who have been accused of such crimes. When your medical license is on the line, you want the best attorneys to help you out.