Medical billing is a complex system, with confusing and evolving regulations, procedures, and coding requirements. A misunderstanding of the medical bill by a patient or health care provider can open the door for a federal fraud investigation. Being accused of a crime after a simple mistake or misinterpretation can be a frightening ordeal. Fortunately, a Virginia federal healthcare fraudulent billing lawyer can stand in and fight for those who have been accused of healthcare fraud. Consult with a Virginia federal healthcare fraud lawyer today if you have been accused.
What is Fraudulent Billing in Health Care?
Most federal health care fraud charges—including Medicare fraud—involve allegations of fraudulent billing by a health care provider. In these cases, “fraud” describes any intentional attempt to misrepresent the services, procedures, or equipment provided to a patient in an effort to receive more compensation than the actual provided services would merit.
Following are some examples of fraudulent medical billing:
- Billing for services that were never provided or procedures that were never performed. This may be done through padding an existing medical bill or through creating false invoices through identity theft.
- Billing for more expensive services, procedures, or equipment than what was actually provided to the patient. This is often known as upcoding.
- Using false or inflated diagnostic codes in order to justify procedures that are not medically necessary.
- Misrepresenting non-covered procedures as covered, medically-necessary procedures.
- Unbundling, or billing separately for each service or procedure that should be billed together under a single CPT code.
- Balance billing or billing the patient more than his or her co-pay amount.
If a health care provider is accused of fraudulent billing in Virginia, finding a federal health care fraud lawyer is important to preserving the provider’s rights during an investigation and building a strong defense against federal fraud charges.
What are the Penalties for Federal Health Care Fraud?
Federal criminal law contains two main statutes pertaining to health care fraud and outlining the penalties for conviction:
- 18 U.S. Code 1347 – Health care fraud – Under this statute, it is a federal felony to attempt to defraud any health care benefits program. Typically, health care fraud is punishable by a maximum term of 10 years in prison. However, if a health care fraud scheme leads to a person’s injury or death, the maximum penalties are increased: 20 years for serious injury and a possible life sentence if a death results.
- 18 U.S. Code 1035 – False statements relating to health care matters – This law is a lesser offense relating to health care fraud. Under this statute, making any false statement or misrepresentation in order to receive health care benefits is a crime punishable by a maximum of 5 years in prison.
Whether federal health care fraud charges have you facing 5 years or life in prison, you deserve competent legal counsel. Finding a fraudulent medical billing lawyer to handle your case can give you peace of mind and a fighting chance against federal prosecution.
How Can a Virginia Federal Healthcare Fraudulent Billing Lawyer Help?
From investigation through trial, a federal defendant has rights that must be observed and protected. Among those rights are the right to be free from unreasonable search and seizure, the right to be considered innocent until proven guilty, and the right to effective assistance of counsel. A Virginia federal health care fraudulent billing lawyer can work diligently to protect and preserve those rights while zealously defending you against federal fraud charges.
Being accused of a federal crime can seem bleak, but no matter how strong the government’s case against you may seem, you have defense options that allow you to fight back. Call today to learn more.
