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Health Care Fraud Lawyers

May 26, 2020

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.

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NYC Health Care Fraud Lawyers

July 19, 2016 New York Lawyers

Defend Health Care Fraud Charges with a Winning Legal Team

Under the Health Insurance Portability and Accountability Act of 1996, also known as HIPAA, heath care fraud is considered a federal offense. Being charged with this type of fraud carries a prison sentence of up to 10 years. Seeking experienced legal advice immediately is recommended if you are accused of health care fraud, or even if you suspect that you are under investigation.

What is Health Care Fraud?

Health care fraud is classified as a white collar crime where filing dishonest health care claims are made to receive a profit. Schemes involving this type of fraud comes in many different forms. Practitioner schemes may involve a host of situations such as:

• Modifying medical records
• Intentionally not reporting accurate diagnoses or procedures to maximize the amount of a payment
• Using unlicensed staff
• Using fully covered or subsidized prescription medication that is not needed to sell for a profit on the black market
• Filing duplicate claims for one service rendered
• Billing practitioners when services for that care was never rendered
• Altering description, dates or identities of members regarding services
• Giving or accepting kickbacks for referrals
• Billing services not usually covered as a covered service
• Prescribing treatment that is not necessary to render care

Not only are providers and practitioners subject to charges, but members of insurance programs can also commit health care fraud. Some actions noted are using transport benefits for nonmedical reasons, selling prescription drugs, providing false information when applying for health services or programs and loaning an insurance card or using someone else’s insurance card.

Once an act of health care fraud is perpetrated, the provider passes the costs to customers. The pervasiveness of this type of fraud has led to statistics where 10 cents of every dollar in health care goes toward paying for fraudulent claims.

How Attorneys Assist You with Fraud Matters

Many times, individuals who get arrested for perpetrating the health care system are unaware that they behavior was actually illegal. In some situations, the individual is inadvertently caught up in a fraud scheme.

Unfortunately, the law does not recognize ignorance of the law as a defense. If you are being investigated for possible health care fraud, you should speak with a skilled criminal defense attorney familiar with the types of cases related to this matter. None of the behaviors that constitute health care fraud in New York should be taken lightly.

Defending Health Care Fraud Charges

The criminal lawyers at Raiser & Kenniff, PC offers skilled legal counsel when you are facing charges for all types of fraud, including health care. We can assist you with these issues pertaining to your case:

• Pleading requirements regarding the five degrees of health care fraud in New York. The prosecution must prove that a defendant acted with the intent to defraud. Also pertinent is proving that a defendant knowingly and willfully providing information that was false in order to request and receive an excessive payment from a health plan for a service or item.
• Discovery issues focused on the health and diagnosis of one or more individuals. This is because most fraud claims are related to either false or exaggerated medical conditions.
• Key witness testimony. Medical doctors and insurance experts are usually the most reliable witnesses in a health care fraud case.

We Help You Build a Strong Defense

It is possible to build a strong defense against charges of fraud in a health care case with the right legal team by your side. With 30-years plus of combined experience, Raiser & Kenniff, PC is the firm you can trust. Respected and knowledgeable, our team works tirelessly to defend clients’ reputation against fraud charges.

NYC Health Care Fraud Lawyers

July 19, 2016

Defend Health Care Fraud Charges with a Winning Legal Team

Under the Health Insurance Portability and Accountability Act of 1996, also known as HIPAA, heath care fraud is considered a federal offense. Being charged with this type of fraud carries a prison sentence of up to 10 years. Seeking experienced legal advice immediately is recommended if you are accused of health care fraud, or even if you suspect that you are under investigation.

What is Health Care Fraud?

Health care fraud is classified as a white collar crime where filing dishonest health care claims are made to receive a profit. Schemes involving this type of fraud comes in many different forms. Practitioner schemes may involve a host of situations such as:

• Modifying medical records
• Intentionally not reporting accurate diagnoses or procedures to maximize the amount of a payment
• Using unlicensed staff
• Using fully covered or subsidized prescription medication that is not needed to sell for a profit on the black market
• Filing duplicate claims for one service rendered
• Billing practitioners when services for that care was never rendered
• Altering description, dates or identities of members regarding services
• Giving or accepting kickbacks for referrals
• Billing services not usually covered as a covered service
• Prescribing treatment that is not necessary to render care

Not only are providers and practitioners subject to charges, but members of insurance programs can also commit health care fraud. Some actions noted are using transport benefits for nonmedical reasons, selling prescription drugs, providing false information when applying for health services or programs and loaning an insurance card or using someone else’s insurance card.

Once an act of health care fraud is perpetrated, the provider passes the costs to customers. The pervasiveness of this type of fraud has led to statistics where 10 cents of every dollar in health care goes toward paying for fraudulent claims.

How Attorneys Assist You with Fraud Matters

Many times, individuals who get arrested for perpetrating the health care system are unaware that they behavior was actually illegal. In some situations, the individual is inadvertently caught up in a fraud scheme.

Unfortunately, the law does not recognize ignorance of the law as a defense. If you are being investigated for possible health care fraud, you should speak with a skilled criminal defense attorney familiar with the types of cases related to this matter. None of the behaviors that constitute health care fraud in New York should be taken lightly.

Defending Health Care Fraud Charges

The criminal lawyers at Raiser & Kenniff, PC offers skilled legal counsel when you are facing charges for all types of fraud, including health care. We can assist you with these issues pertaining to your case:

• Pleading requirements regarding the five degrees of health care fraud in New York. The prosecution must prove that a defendant acted with the intent to defraud. Also pertinent is proving that a defendant knowingly and willfully providing information that was false in order to request and receive an excessive payment from a health plan for a service or item.
• Discovery issues focused on the health and diagnosis of one or more individuals. This is because most fraud claims are related to either false or exaggerated medical conditions.
• Key witness testimony. Medical doctors and insurance experts are usually the most reliable witnesses in a health care fraud case.

We Help You Build a Strong Defense

It is possible to build a strong defense against charges of fraud in a health care case with the right legal team by your side. With 30-years plus of combined experience, Raiser & Kenniff, PC is the firm you can trust. Respected and knowledgeable, our team works tirelessly to defend clients’ reputation against fraud charges.

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