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DC Federal Healthcare Overbilling Lawyer

Medical treatments are assigned a Current Procedural Terminology (CPT) code and a list of CPT codes are submitted to insurers for payment. Insurers pay health care providers a designated sum for each covered treatment. Healthcare providers are expected to bill only for services rendered, and to choose the correct code for each service. Law enforcement agents often investigate providers in an effort to discover billing for services not performed, the performance of unnecessary services, or the billing of inappropriate CPT codes to receive higher payments. A DC federal healthcare overbilling lawyer can provide legal representation to healthcare professionals who have been accused of fraudulent behavior.

Investigation for or a conviction for healthcare fraud can result in forfeiture of assets, the loss of a medical license, large fines, or prison time. You should strongly consider contacting a DC federal healthcare overbilling attorney as soon as possible for help responding to an investigation and fighting to avoid conviction if you are accused of fraud.

Penalties for Healthcare Overbilling

Accusations of overbilling may occur as a result of:

  • Unbundling: Medical treatments with multiple steps or parts are broken down and each part is billed individually instead of billing for the entire treatment under one code.
  • Upcoding: A more expensive CPT code is chosen than is appropriate for the treatment actually provided.
  • Double billing: Providers charge more than once for the same service, or two providers bill for the same procedure provided to the same patient.
  • Unnecessary or excessive treatment: Unnecessary medical services are provided for purposes of billing for those services.
  • Billing for treatment not provided: Insurers are charged for services a patient never received.

Federal laws impose both civil and criminal penalties for overbilling. Penalties may include:

  • Fines up to $10,000 per instance of overbilling. 42 U.S.C. 1320a-7a establishes civil fines when incorrect codes are used to obtain higher payments or when any fraudulent claim for payment of medical services is made knowingly.
  • Up to 10 years of incarceration for healthcare fraud. 18 U.S.C. 1347 defines healthcare fraud as any attempt to participate in a scheme to willfully commit fraud in connection with providing medical service or receiving payments for services. Any willful misstatements; false promises; or material misrepresentations in connection with healthcare services or payments is also considered fraud.
  • Up to five years of incarceration for false statements relating to health care matters under 18 U.S.C. 1035.
  • Up to five years of incarceration for interfering with a federal audit under 18 U.S.C. 1516. Audits are typically the first step when Centers for Medicare and Medicaid Services suspects healthcare overbilling or fraud.

A charge of fraud can result in your assets being frozen under 18 U.S.C. 1345. The government is also able to seize personal and real property under 18 U.S.C. 982 if it is likely the property was acquired as part of a healthcare fraud scheme.

Contacting a DC Federal Healthcare Overbilling Lawyer

Prosecutors generally must show that overbilling was intentional in order for you to be assessed civil penalties or face incarceration for the crime of overbilling. A DC federal healthcare overbilling lawyer can assist you in arguing:

  • No overbilling occurred.
  • Any overbilling that occurred was the result of a mistake or oversight, rather than intentional fraud or misstatements.
  • There is insufficient evidence to prove you engaged in overbilling.

Prosecutors have a tougher job in criminal, rather than civil, cases. A prosecutor must prove guilt beyond a reasonable doubt to convict you of a crime.  Your DC federal healthcare overbilling lawyer can help fight fines, jail, and other penalties. A federal overbilling attorney in DC may also be able to help negotiate a settlement where you keep your license and even continue to receive Medicaid and Medicare payments.

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