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Federal Healthcare Fraud Schemes: Upcoding

Being charged with any federal healthcare fraud crime is very serious, let alone the allegation of upcoding.  A MD federal healthcare upcoding allegation might require an experienced and professional Maryland federal healthcare fraud attorney who has experience handling these unique cases.

An attorney may be able to explain your defense options while taking steps to lessen some very harsh penalties. An experienced Maryland federal healthcare upcoding lawyer can work with you to try and achieve a positive result in your upcoding case.

Benefits of Working with a Federal Defense Attorney

The penalties associated with healthcare fraud are harsh and highlight the need for qualified counsel.  An experienced federal healthcare upcoding lawyer in Maryland can search for reasons that you may have been incorrectly charged and build a strong defense.

In today’s world, it is possible for simple clerical errors to be compounded by automated computer billing systems. By working with a healthcare fraud attorney who understands the way that medical billing works, he or she can review your records to determine what defenses may be available to you.

About Federal Upcoding Charges

When Medicare and Medicaid are billed for medical services, a series of numerical codes are used.  These codes are necessary because they are used to identify the exact medical exams, procedures, or tests that were performed so that a proper reimbursement may be issued.

“Upcoding” occurs when you use a code for an exam, procedure, or test that was not actually performed, for the purpose of increasing the reimbursement rate.

One unique example of upcoding occurred when the CEO of Mobile Doctors was accused of billing Medicare with two of the highest codes, which yielded individual fees of $124.86 and $173.52, rather than using the more appropriate lower codes, which would have charged $54.44 and $82.34.  The complaint indicates that Mobile Doctors received approximately $34 million between 2006 and 2012, by way of using the higher, incorrect codes.

Consequences of Federal Healthcare Upcoding

Because there are many types of healthcare fraud, it can sometimes be confusing to determine which penalty applies to your specific charge.  However, 18 U.S. Code Section 1347 and Section 1035 cover the crime of upcoding.

A person convicted of upcoding under Section 1347 and 1035 can be sentenced to federal prison, as well as be forced to pay a fine. The severity of the effects the fraud has on a patient can also determine the length of the prison sentence and/or the amount of the fine.

Speak with a Federal Defense Attorney

Are currently facing a federal healthcare upcoding charge? If so, you should consult with an experienced Maryland federal healthcare fraud upcoding lawyer. Our attorneys have experience dealing with federal healthcare fraud cases and are available to speak with you.

Call our Maryland law offices as soon as possible to complete your free legal consultation.