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Health Care Fraud Lawyers

Health care fraud encompasses health insurance fraud, medical fraud, and drug fraud. Health insurance fraud can occur when an individual or a company defrauds a government health care program (i.e., medicare) or an insurer. Health care fraud is known as a white collar crime in which individuals or groups file health care claims dishonestly in order for themselves to receive monetary gain. The methods in which health care fraud is done differ as individuals who engage in health care fraud are usually finding new ways to accomplish fraud. The money and other damages that are incurred by fraud can be recovered through the use of the federally mandated False Claims Act. According to the Federal Bureau of Investigations (http://www.fbi.gov), health care fraud costs tax payers in the United States of America $80 billion each year. In 2010, $2.5 was recovered through litigation involving the False Claims Act. Also in 2010, individuals (i.e., whistleblowers) reporting health care fraud were paid approximately $307,620,400 for their efforts in reporting health care fraud.

A large amount of health care fraud is conducted by organized crime syndicates as well as a minority of health care providers who are dishonest. Common types of health care fraud include the following:

  • Billing for services not rendered
  • Unnecessary services
  • Kickbacks
  • Filing duplicate claims
  • Upcoding of items
  • Unbundling
  • Upcoding of services
  • Excessive Services
  • Copying and pasting entries into medical records

– Billing for services not rendered: This occurs when patient information is used to fabricate claims or through padding of claims with charges for services or procedures that did not occur.
– Upcoding: This occurs when someone bills for more expensive procedures or services than the services that were actually administered or provided. This often requires the provider to change the patient’s diagnosis to a more serious condition in order to inflate the price of the procedure they are claiming.
– Provision of unnecessary services: This occurs when a provider performs unnecessary services in order to generate higher insurance payments.
– Misrepresentation of treatments that are not covered as medically necessary treatments in order to obtain insurance payments. This is often done in cosmetic surgery fraud. In cosmetic surgeries, sometimes non-covered cosmetic procedures (i.e., nose jobs) are billed to insurance companies as medically necessary (i.e., repair to deviated-septum).
– Falsification of a patient’s diagnosis in order to justify tests that are not needed, surgeries, or other procedures that are not necessary.
– Unbundling: Billing insurance each step of a procedure, making it seem that each step was a separate procedure.
– Billing a patient an amount that is more than the co-pay for services that are already paid for by the insurance company under the terms of the contract.
– Kickbacks: Accepting kickbacks for referrals of patients.
– Waiving patient deductibles or co-pays for dental or medical care and over billing the benefit plan or insurance company.

There are several ways in which an individual can report cases of fraud. If an individual or health care provider suspects they have witnessed a case of health care fraud, they should contact the Federal Bureau of Investigation by contacting their local office, online tips form, or by telephone. Individuals who suspect or are the victim of fraud should contact an attorney for consultation in order to ensure that the government actively pursues the fraud claim. Attorneys that are experienced in litigation regarding the False Claims Act should be contacted for consultation. An attorney that specializes in fraud and the False Claims Act can advise individuals of their protections, rights, and what evidence they must have to create a solid case against the group or individual who has committed the alleged health care fraud. Individuals who are convicted of health care fraud can receive serious consequences including fines, incarceration, and may lose the right to practice medicine indefinitely.


Charle Butler
Charle Butler
2021-03-12
Verified
I was hesitant to hire the Spodek Law Group. I read reviews and knew they have a great reputation. However, I thought I would spend money and not see or speak to my attorney. From the beginning to end of my case Todd and the entire staff were available and willing to help. We worked towards and end result that was way above my expectation and Todd delivered. I am forever grateful for patience and long days and night spent working on my case. Thanks Todd and the entire team!
Mesonista parsons
Mesonista parsons
2021-03-05
Verified
My attorney at Spodek was Abigail. She was very knowledgeable and helpful with all my questions and concerns, as well as responsive. Her fees are affordable and Abigail took the time to make sure I understood everything relating to my case. I highly recommend Abigail and will request her services in the future.
debabrata chakraborty
debabrata chakraborty
2021-03-03
Verified
Todd A Spodek is the experienced and best criminal lawyer at USA. He is very professional and always respond on time. Alex also very cooperative and always help me. They took care me and my problem like family member. I am 100% satisfied for their professional service. My result was unexpected and amazing. They dismissed my case. I am really grateful to them. I will recommend you to go there if you want to solve your problem. I wish all the best for them.
Asata Hendricks
Asata Hendricks
2021-03-02
Verified
Truly appreciate the work the guys did!. Exceptional team & I know they care about each and everyone of their clients. I am super thankful to be referred to Spodek Law Group and I am grateful Todd & Alex were able to work diligently to achieve an outcome I am pleased with. Despite COVID they stayed on top of things and kept me informed every step of the way. Very thankful.
Mike Moroff
Mike Moroff
2021-02-26
Verified
I'm very satisfied with the services rendered by Todd, Alex and Mary Lou. I whole heartedly recommend Spodek Law Group . I've worked with and have retained other attorneys in the past with Todd's firm being the cream of the crop for many reasons. A very serious legal matter was resolved after a year's hard work and effort. Todd expertly guided me through the process and was able to navigate and make the good journey bearable as well as successful. Mary Lou initially provided excellent assistance before referring my case to Todd. Alex's support was effective and timely. The customer portal (MyCase) is an invaluable communication tool that also kept track of my case. Various aspects of my case were explained and there were several options provided but I made the final decision of how the case would be handled. The legal fee was reasonable considering the effort and amount of work plus it was a flat fee regardless of the length of time required to conclude my case. Todd made himself available to me and we had many scheduled meetings to go over the progress and to discuss the next steps. I felt more confident after many discussions with him. You will not go wrong choosing Spodek Law Group for legal matters.
Josh Katz
Josh Katz
2021-02-24
Verified
Being that it was the first time that I was in need of an attorney, I was afraid and hesitant and knew I needed the absolute best. It is beyond understood why Spodek Law Group has a reputation of being the top, if not the best law firm in New York. Alex and Abigail were there every step of the way even at the most unconvenient hours. I could not have asked for more. They are extremely good at what they do and they delivered much much more than just winning my case. A big thank you to Alex and Abigail for all the guidance and counseling and their upmost loyal support that extended far more than just legally. If you need the absolute best than don't hesitate to hire Spodek Law Firm.
L.C.
L.C.
2021-02-24
Verified
I cannot tell you how thankful I am to Todd and Alex for their hard work and dedication to my case. I had never been in any trouble before but I had an unfortunate event occur and in the midst of COVID-19 at that therefore I knew I needed a team that was dedicated to my success. Today- my case has been finalized and I’m walking away with no record and can continue life as a mother and a Grad student worry free. I cannot express enough gratitude for their assistance.
AnnMarie Soliman
AnnMarie Soliman
2021-02-23
Verified
I received a summons and called Spodek law group for a free consultation. Alex took my call and was very quick and responsive. He was available anytime through multiple platforms and very reassuring when needed. They are extremely organized and thorough. They got my case dismissed! I’m very grateful. Thank you Alex and Todd!

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"Spodek Law Group have offered me excellent support and advice thru a very difficult time. I feel I've dealt with someone who truly cares and wants the best outcome for you and yours. I'm extremely grateful for all the help Spodek Law Group has offered me. I can't recommend them..."

David Bruce

"Spodek Law Group was incredibly professional and has given me the best advice I could wish for. They had been helpful and empathetic to my stressful situation. Would highly recommend Spodek Law Group to anyone I meet."

Rowlin Garcia

"Best service I ever had. Todd is absolutely class personified. You are in the safest hands with spodek. They have their clients interest in mind."

Francis Anim
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