When a patient receives medical services, a Current Procedural Terminology (CPT) code is assigned by the treatment provider. The CPT code is used to bill insurers, with each CPT code assigned a particular payment amount. Law enforcement agents routinely investigate instances in which codes are incorrectly assigned, resulting in a CPT code that results in higher payments.
If you become aware that you are being investigated for potential upcoding violations, a DC federal healthcare upcoding lawyer can help advocate for your legal rights.
42 U.S.C. 1320a-7a establishes civil penalties for upcoding. A DC federal healthcare upcoding lawyer should be contacted as fines of $10,000 may be assessed for each instance in which a claim is submitted using a code that results in a greater payment than should be applicable for the service provided.
The Health Insurance Portability and Accountability Act (HIPAA) also establishes criminal penalties if the upcoding is deemed to be part of a scheme to commit healthcare fraud and/or if false statements were made in connection with the payment or provision of healthcare services.
A healthcare provider accused of upcoding may be charged under:
Involvement in a scheme to commit fraud in connection with payments for medical care or delivery of care. Willfully making misstatements or false representations to obtain money or property from a health care benefit program is also considered fraud. Penalties can include up to 10 years incarceration.
It’s important to note that 18 U.S.C. 1345 gives prosecutors the ability to seek to freeze your assets if you are suspected of a fraud offense. 18 U.S.C. 982 gives authorities the right to permanently seize personal and real property believed to have been acquired as part of a fraud scheme. To learn more about the penalties you could potentially be facing contact a DC federal healthcare upcoding lawyer as soon as possible.
A DC federal healthcare upcoding lawyer can represent you if you are under investigation or formally charged with upcoding. An attorney can help you to present one or more of the many potential defenses available, such as:
The codes were appropriate for the treatment services you provided.
An experienced DC federal healthcare upcoding lawyer can fight for you in court or help to negotiate a settlement authorities seek criminal or civil penalties for upcoding. Your lawyer can work to preserve your medical license and as part of some settlements, you may continue to be eligible to receive Medicare, Medicaid, and other government insurance payments.
David Benowitz and his firm are the best strategic and compassionate teams you will work with. Mr. Benowitz and his team are diligent and proactive, which is further enhanced by David’s methodic and strategic approach to law. My case was a very complicated and emotionally charged case involving classified information, where I was facing three indictments, two carrying life sentences and one carrying 20 years. Mr. Benowitz utilized a network of lawyers coupled with his own strategy to navigate the case to success! I sincerely recommend David Benowitz quite literally with my life.
I found David to be very dedicated to fighting for your loved one’s rights. I also highly appreciated the fact that David kept us informed and empowered throughout the whole process.
Mr. Benowitz is an incredibly knowledgeable and dedicated professional. His commitments to social justice and community outreach are exemplary. I wholeheartedly recommend him for any matter.