While many acts of fraud in Virginia are prosecuted as state crimes, healthcare fraud is a federal offense prosecuted by the United States government. Allegations of health care fraud come from a number of suspicious billing activities, including upcoding, false billing, and unbundling. Being accused of Medicare fraud or other health care fraud can be stressful and frightening. Securing legal defense representation from a Virginia health care unbundling lawyer can give you the resources necessary to fight federal fraud charges. Call today to recieve a free consultation from a Virginia federal healthcare fraud lawyer.
What is Unbundling in Health Care Fraud?
One of the most common schemes in health care fraud is “unbundling.” Health care billing is performed by assigning codes to each medical procedure through the Healthcare Common Procedure Coding System (HCPCS) or a Common Procedural Terminology (CPT) code. Often, procedures and medications that are frequently performed and provided in conjunction with each other are grouped together under a single code. Unbundling occurs when a health care provider fails to use the unified HCPCS or CPT code and instead bills for each step of the procedure or medication provided with a separate code.
The Centers for Medicare and Medicaid Services (CMS) specify which procedures may be unbundled and which must be billed under a single code. Health care providers must be certain they understand the CMS requirements for bundling in order to make sure they are billing correctly. By unbundling against CMS regulations, a health care provider can face federal criminal charges for health care fraud in Virginia. If you are facing healthcare charges consult with a Virginia federal healthcare unbundling lawyer to learn more.
Health Care Fraud Unbundling Penalties
Criminal penalties for health care fraud depend upon the specific statute or statutes a person is convicted of violating. There are two main federal laws related to health care fraud:
- 18 U.S. Code 1347 – Health care fraud
- 18 U.S. Code 1035 – False statements relating to health care matters
Whenever possible, U.S. attorneys will prosecute under the statute which allows for the heaviest penalties. Health care fraud, or the willful attempt to defraud any health care benefits program, including Medicare or Virginia Medicaid, has a maximum sentence of 10 years in prison. However, if serious bodily injury occurs as a result of the offense the maximum penalty is increased to 20 years. And if death occurs as a result of the fraudulent scheme, the maximum penalty is increased to life imprisonment.
Making a false statement or concealing a material fact in connection with a health care benefits program has a maximum penalty of 5 years in prison.
How Can a Virginia Health Care Unbundling Lawyer Help?
In order obtain a health care fraud conviction, federal prosecutors must prove that the defendant “knowingly and willfully” committed the fraud, misrepresentation, deception, or concealment in order to receive payment from the health care benefits provider.
A federal health care unbundling attorney in Virginia can carefully construct a defense that may include challenging the prosecution’s evidence of intent to commit a crime.
During a free consultation with a Virginia federal healthcare fraud unbundling lawyer, you may begin to discuss defense options and strategies that will most benefit your case. From negotiating a plea to a lesser charge to vigorously defending your innocence at trial, your health care fraud attorney should consider all options to uncover the optimal strategy for your unique case.
