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Virginia Federal Healthcare Upcoding Lawyer

If you are accused of health care fraud, you know how quickly the allegations begin to affect your personal and professional life. You understand that the federal charges you face could wreak havoc on your career, and you are likely worried about the potential penalties you face if convicted. Fortunately, a Virginia federal health care upcoding lawyer can help you fight allegations of upcoding and other types of health care fraud. Call today to schedule a consultation with a Virginia federal healthcare fraud lawyer to discuss your case.

Understanding Health Care Fraud: Upcoding

Health care spending in the United States reaches upwards of $3 trillion each year, and researchers with the Journal of the American Medical Association (JAMA) estimate the annual cost of Medicare fraud to reach $98 billion. While both patients and providers commit health care fraud, most federal health care fraud prosecutions involve providers. This can place health care providers, including doctors, medical supply companies, and others under intense federal scrutiny.

A large portion of health care fraud is committed through false billing. There are several ways fraudulent invoices are submitted for reimbursement. One of the most common is upcoding. Every medical service and procedure is assigned a Current Procedural Terminology (CPT) code. Upcoding in medical billing occurs when the provider assigns a different CPT code than that associated with the service or procedure actually provided, resulting in higher payment or reimbursement.

The Office of Physician Billing Compliance with University of Florida Health says that there are currently 7,800 different CPT codes, which must be associated with the correct diagnostic code (ICD-9) for appropriate billing.  A simple mistake in coding can open the door for suspicion and investigation of fraud.

A federal health care upcoding lawyer in Virginia can build a strong defense against federal fraud charges, helping you preserve your rights and your reputation.

Federal Health Care Fraud Penalties

Conviction of health care fraud can result in harsh penalties. The primary federal health care fraud law is found in 18 U.S. Code 1347 , which makes upcoding and other acts of fraudulent billing a felony typically punished by a maximum of 10 years in prison. However, if a person is seriously injured or dies as a result of fraudulent health care activity, the penalty is increased to a maximum of 20 years or life in prison, respectively.

While medical upcoding is generally prosecuted under the federal health care fraud statute, there are other federal fraud laws which may also apply. The United States government may be quick to file additional charges in connection with the same alleged health care fraud offense.

  • Making false statements relating to health care matters (18 U.S. Code 1035)
  • Wire fraud (18 U.S. Code 1343)
  • Mail fraud (18 U.S. Code 1341)
  • Conspiracy (18 U.S. Code 371)

A federal fraud attorney who understands health care upcoding fraud cases can work for the dismissal of inappropriate charges and challenge the government’s evidence against you.

Finding Federal Health Care Fraud Defense in Virginia

The federal government wins a large percentage of its prosecutions, and most of these convictions are obtained through a plea bargain. While a negotiated plea may be the best course of action for a fraud case, it is important to find a federal defense attorney who is not afraid to go the distance in defending your innocence at trial.

A federal health care upcoding lawyer can help get a fair result for your case by carefully evaluating the details of the alleged offense, scrutinizing and challenging the prosecution’s evidence, and providing legal counsel to help you make the right choices regarding your defense.

Call to learn more about how our Virginia federal health care fraud lawyers can help you.