Medical costs are high, and health care spending in the United States averages $3 trillion each year. Often, patients and health care recipients do not understand the charges they incur as a result of a medical procedure or service, and this can lead to accusations of medical overbilling. Health care providers accused of fraud are placed under intense scrutiny, finding their professional reputations in jeopardy. In some cases, these allegations by patients and insurers lead to federal health care fraud charges. When a health care provider is accused of fraud, a Virginia federal health care fraud overbilling lawyer can step in to fight the charge. Call today and get a free consultation from a Virginia federal healthcare fraud lawyer.
Federal Health Care Fraud: Overbilling
The most common type of health care fraud is overbilling, an act which can take many different forms. Although the majority of health care fraud in the United States is committed by only a tiny fraction of health care providers, allegations of rampant fraud can place even the most ethical providers under suspicion. Fortunately, a federal health care fraud lawyer can represent providers accused of overbilling to protect their rights and preserve their reputations.
Medical overbilling takes many forms:
- Upcoding, or using a CPT code or diagnostic code for a more expensive service, procedure, or equipment than that which is actually provided
- Unbundling, or billing separately for each service or step in a procedure which should be included in a single, unified code
- Billing for services not actually provided or procedures not actually performed
When a patient or insurance provider receives an invoice from the medical provider, there is often a sense of “sticker shock.” Frequently, the recipient of a medical bill does not understand the charges and may wrongfully accuse a provider of overbilling. Other times, a provider may be confused by the changing coding requirements and inadvertently make an error in billing.
When allegations of overbilling lead to a federal health care fraud investigation, it is critical for the accused health care provider to secure legal defense representation from a Virginia federal healthcare overbilling lawyer as quickly as possible.
Federal Penalties for Health Care Overbilling Fraud
Health care fraud (18 US Code 1347) is defined in federal law as the knowing and willful execution or attempted execution of a scheme to defraud a health care benefits program or to obtain money or property from a health care benefits program by “false or fraudulent pretenses.”
This federal law prescribes a sentence of up to 10 years in prison for health care fraud, up to 20 years in prison if a person is injured in the commission of health care fraud, and up to life in prison if the act results in death.
In federal law there is another statute pertaining to health care fraud in 18 US Code 1035. This law makes it a crime to make any false statement or misrepresentation in connection with the payment of health care benefits or delivery of health care services. This type of health care fraud carries a maximum penalty of 5 years in prison.
Federal Health Care Overbilling Defense in Virginia
Being accused of medical overbilling is a serious matter. An accused health care provider’s career may be on the line, and a federal criminal conviction can leave a devastating impact beyond the initial sentence.
A Virginia federal health care overbilling lawyer can help. By carefully evaluating your case, a federal fraud defense attorney can craft an appropriate defense strategy, whether that means negotiating a plea that minimizes any negative consequences or aggressively defending you at trial for an acquittal of charges.
If you know or suspect that you are under investigation, suspected of health care fraud, act now to get the legal representation you need. Call for a risk-free consultation with a healthcare fraud overbilling defense lawyer in Virginia.
