Medical Billing Fraud

Work with a Medical Billing Fraud Defense Attorney

The unfortunate fact is that insurance companies generally do not pay doctors as much as they once did for the same services they performed in the past. When insurance companies began to offer reduced reimbursement, there was a subsequent increase in the number of doctors accused of medical billing fraud. If you are in this situation, contact Simmons Wagner, LLP at (949) 439-5857 for a legal consultation.

What is Medical Billing Fraud?

When a doctor or someone acting on their behalf makes a false claim to a healthcare program, they might be guilty of medical billing fraud. The government must prove several elements including:

  • The defendant made a false claim to a healthcare company or program (including Medicare and Medicaid)
  • The defendant devised a scheme to defraud a healthcare benefit program
  • The defendant executed their scheme

Examples of medical billing fraud can include:

  • Fraudulent billing: Billing for services, equipment, or treatment for a patient that never used or received the services, equipment, or treatment.
  • It can be more expensive to bill an insurance company for every individual service rather than bundling them together. For example, if the doctor spreads out several medical tests over several visits instead of doing it in one. If the doctor does this with the intention of increasing the amount they will be reimbursed, then they have committed medical billing fraud.
  • If a healthcare professional intentionally changes their medical billing code to take the place of the actual services they provided and instead use a code for a more expensive procedure or type of care, this is upcoding and it is against the law.

These are only a few of the situations in which medical billing fraud can be charged.

The Consequences for a Conviction Can Be Severe

It is important to have the right attorney because if you are found guilty of medical billing fraud, you could be facing:

  • Up to five years in prison
  • Fines of as much as $250,000

The government takes these charges very seriously and they should be fought aggressively.

Defense Options for Charges of Medical Billing Fraud

If we can show that even one element of the prosecution’s case is not valid, then we can potentially have the charges dropped or earn you a not guilty verdict. We might do this by showing any of the following:

  • You were not the one who submitted the inaccurate billing.
  • You did not know the billing you submitted was inaccurate and therefore did not have the intent to defraud the insurance company or insurance program.
  • The billing you submitted was accurate.

If there is a mountain of evidence pointing toward your guilt, this does not mean that your only option is to plead guilty. We will start by looking to ensure that all evidence against you was legally obtained. If it was not, then we might be able to have some or all of the evidence disqualified.

If necessary, we will fight aggressively to get you the best possible plea deal. This could result in a significantly lower punishment that will not have the long-term consequences you would otherwise face.

The Next Step is to Contact an Experienced Medical Billing Fraud Defense Attorney

The bad news is that these can be highly technical trials with many witnesses, experts, and audits. The good news is that you have found a law firm that is up for the challenge. At Simmons Wagner, LLP we have the experience, resources, and commitment to provide you with the strongest possible defense. Call us now at (949) 439-5857 for a consultation.