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DC Federal Healthcare Upcoding Lawyer

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.

Potential Penalties for Upcoding

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:

  • 18 U.S.C. 1347, which defines healthcare fraud as willful

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.

  • 18 U.S.C. 1035, which imposes up to a five year prison sentence for making false or misleading statements or misrepresentations in connection with payment for health services or delivery of health benefits.
  • 18 U.S.C. 1518, which imposes up to a five year prison sentence for obstructing, or attempting to obstruct, any criminal investigations designed to uncover healthcare fraud.

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.

How Can a DC Federal Healthcare Upcoding Lawyer Help?

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.

  • Any incorrect coding was unintentional.
  • There is insufficient evidence of a willful attempt to engage in fraudulent behavior.

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.

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