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DC Federal Healthcare Fraudulent Billing Lawyer

Health care providers are expected to bill the correct Current Procedural Terminology (CPT) codes for each service rendered. Law enforcement agencies often initiate investigations in an effort to uncover the intentional submission of  false claims to obtain more compensation than is due, which may ultimately result in civil and criminal penalties for fraudulent billing.  Since large fines and potential jail time are possible outcomes if someone is found guilty of fraudulent billing, you should contact a DC federal healthcare fraudulent billing lawyer if you are under investigation or have been accused of fraud.

Penalties for Fraudulent Healthcare Billing

Law enforcement agents investigate many forms of potential fraudulent healthcare billing which may warrant contact with a DC federal healthcare fraudulent billing lawyer, including the following:

  • Billing for services not provided.
  • Billing for services that were more expensive than the services provided.
  • Performing services that are medically unnecessary to obtain compensation.
  • Misrepresenting treatments as medically necessary to obtain insurance payments.
  • Falsifying a patient’s diagnostic reports to justify unnecessary procedures.
  • Unbundling services, or billing for each step of a treatment rather than one code for the entire procedure.
  • Accepting or offering kickbacks for patient referrals.
  • Waiving deductibles for patients and overbilling insurers.
  • Making false statements to insurers when submitting bills.

Investigating agencies may attempt to deem any of these activities an illegal attempt to obtain money or property in connection with healthcare services.

Laws imposing penalties for fraudulent healthcare billing include:

  • 42 U.S.C. 1320a-7a: Examples of false claims include upcoding; charging for services not performed; and charging for services not covered.
  • 42 U.S.C. 1320a-7B: Up to five years of incarceration is imposed for making any false statements or misrepresentations of material fact to improperly obtain payments from federal healthcare programs.
  • 18 U.S.C. 1347: Up to 10 years of incarceration is imposed for involvement with efforts to defraud a healthcare program including false promises, material misstatements, and any other actions to improperly obtain money or property from a health insurer.
  • 18 U.S.C. 1035: Up to five years’ incarceration is imposed for making any false statements related to healthcare benefits or payments.
  • 18 U.S.C. 1516 prohibits interfering with an audit for suspected fraudulent billing by the Centers for Medicare and Medicaid Services. A maximum of five years’ incarceration can be imposed following a conviction for a violation of this statute.

How a DC Federal Healthcare Fraudulent Billing Lawyer Can Help

In many cases, the question of whether healthcare fraud occurred is subjective. There could be disagreement over which codes were appropriate. Disputes can also arise regarding whether services were medically necessary. A DC federal healthcare fraudulent billing lawyer can assist you in arguing that you are innocent of charges for fraud or false claims because you billed appropriately.

Fraud charges require a willful attempt to improperly obtain payments from an insurer.  Your DC federal healthcare fraudulent billing attorney can argue that you made a mistake or acted in error, not with an intent to commit fraud. These are just some of the possible defenses to healthcare fraudulent billing charges.  Remember, a prosecutor must show beyond a reasonable doubt that you are guilty of the offenses you are accused of for you to be convicted.

Your DC federal healthcare fraudulent billing lawyer can assist you in choosing the best strategy to defend against these type of charges.

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