Wilmington HealthCare Fraud Attorney

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The pressure is high for healthcare providers in today’s demanding medical landscape. Unfortunately, even unintentional billing or coding mistakes can lead to accusations of healthcare fraud. You must not navigate your challenges alone if you’re facing charges. Our firm has experience with cases like yours and can seek an ideal outcome. We are here for you when you need a Wilmington healthcare fraud attorney.

What Is HealthCare Fraud?

Healthcare fraud is a federal offense involving the undermining of the healthcare system. This illegal practice is believed to harm patients and the programs that seek to help people, including Medicare, Medicaid, and private insurance plans.

Healthcare fraud encompasses a wide range of deceptive practices. Typically, those who commit the crime seek to receive more compensation than they deserve from the healthcare system. While you may recognize some examples, others may seem foreign to you, such as:

  • Billing for services not provided: Sometimes, providers bill programs for incomplete services. While some include phantom office visits, others detail unnecessary tests or procedures.
  • Upcoding services. While this can happen by accident, upcoding happens when a provider claims they delivered a more expensive service than the actual service they performed. This situation can involve detailing a more in-depth examination when a simple routine checkup took place. Upcoding is a misrepresentation of actual services.
  • Duplicate billings. Providers break the law by submitting duplicate bills to collect double payments. This act can include presenting identical bills to organizations like Medicare and private insurance companies in an effort to receive extra payment.
  • Referral kickbacks. It is illegal to offer or receive kickbacks for patient referrals. Agreeing with a lab or other entity to receive compensation for referring patients is against the law. This act is healthcare fraud.

Remember: just because an act was unintentional does not stop the government from accusing you of healthcare fraud. You should seek legal help if you face charges. Whether or not you are innocent, you must proceed cautiously and with the advice of a professional who has successfully navigated the process.

Signs You Are Under Investigation for Healthcare Fraud

Healthcare fraud investigations often start discreetly. However, paying attention to warning signals can help you intervene early. If you are under scrutiny, our Wilmington healthcare fraud attorney can advise you of your rights and how to proceed in the legal process. When facing an investigation, be aware of these red flags:

An Increase in Government Involvement

It is not abnormal for government agencies like Medicare and Medicaid to conduct audits and reviews of your billing practices. If you notice an increase in the frequency of these audits, you could face an investigation. An agency that requires extensive documentation to justify specific billed services can signal trouble for your business.

Medical or Financial Document Subpoenas

A subpoena is a court order requiring you to produce documents. This order is a significant red flag if you receive a subpoena from a government agency. Investigators are likely gathering evidence related to fraudulent activities. While you can be legally required to submit to the subpoena, ensure that you have legal representation before doing so. A skilled attorney can confirm that the subpoena is legitimate and that you should answer it.

Reimbursement Claim Denials

You may have often submitted claims to insurance programs for service reimbursement as a healthcare provider. An unusual rise in denied claims for services you routinely provide can be a bad sign. The payer, in this case, likely suspects fraudulent activity. Your denials can be accompanied by requests for additional information, like justifications for the services in question.

Contact From Law Enforcement

Being contacted by law enforcement is a high-priority red flag. You should proceed with caution if contacted. These officials’ questions about your billing practices or patient care can indicate that they have begun investigating your practice. You should not answer questions without consulting a Wilmington healthcare fraud attorney first.

While this task may seem complicated, you may unintentionally incriminate yourself if you communicate with investigators without legal representation present.

Changes in Employee Conversations or Activity

Healthcare fraud often occurs in secret. If you notice a significant change in internal discussions surrounding billing or procedural concerns, it is crucial to take these signs seriously. These discussions may indicate potential wrongdoing in your organization, causing a heightened risk of investigation.

Early intervention is crucial in healthcare fraud cases. What may seem like a simple misunderstanding at first can look much worse the longer it occurs. You may be under investigation if you notice these signs in your practice. Contacting the W. James Payne Law Firm can ensure you have help in your fight against any accusations. We can guide you through this delicate situation.

How Can I Protect Myself From False Accusations?

You can protect yourself from false accusations by ensuring your practice is proactive. While it is impossible to eliminate all risks, you can significantly reduce your chances of investigation by:

  • Maintaining accurate records. Any service you provide should come with meticulous documentation. Patient records should include the medical necessity for each procedure or test. Clear, detailed records can be invaluable evidence in the face of false accusations.
  • Developing a solid compliance program. Your compliance program should educate your staff on proper practices while helping identify coding errors. Consistent training can help prevent unintentional mistakes that someone may misconstrue as fraudulent activity.
  • Review and enhance billing practices. Regularly audit your practices to identify errors before they become more significant issues. Proactive correction measures can demonstrate good faith and minimize the risk of accusations.

What Is the Difference Between Medicare Fraud and Healthcare Fraud?

The main difference between Medicare fraud and healthcare fraud is that Medicare fraud deals with only Medicare-related issues. In contrast, healthcare fraud is a broad term encompassing many forms of medical fraud. Put plainly, Medicare fraud is a type of healthcare fraud.

Healthcare fraud includes any deceptive activity seeking unearned payment from healthcare programs. These include federal programs like Medicare and Medicaid, as well as issues with private insurance companies. Healthcare fraud can consist of billing for unnecessary services, upcoding procedures, and kickbacks for any program. Medicare fraud also involves those acts but solely targets Medicare reimbursement systems.

What Should I Do If I Am Being Investigated For HealthCare Fraud?

If investigated for healthcare fraud, it is essential to remember you need legal representation. This type of white-collar crime can be detrimental to your livelihood. It is unwise to face these charges alone, even if you believe you can prove the accusations are false. Besides securing legal representation, it is crucial to understand the importance of silence with law enforcement while maintaining transparency with your attorney.

Answering questions from investigators can hurt you in the future. While you may believe an investigator is asking a minor and inconsequential question, these professionals can mislead you into incriminating yourself. If you must speak to an investigator, your attorney should always be present.

Remember, your attorney is your advocate. Adhering to their guidance can help you remain transparent and cooperative with everyone involved in a way that helps your case. Your willingness to address any concerns can help resolve problems quickly. When you believe an incorrect investigation is taking place, remaining helpful but cautious in your investigation is often advised.

Why Do I Need a HealthCare Fraud Attorney?

You need a healthcare fraud attorney because these investigations are complex. The serious federal offenses you face can have severe consequences. Having our attorney by your side can be essential in protecting your livelihood. At our firm, we can:

  • Conduct a thorough investigation. Although agencies will conduct their investigation, we can perform our own to gather the appropriate information for your defense. We can collect witness statements, billing documentation, procedural information, and medical records. Analyzing the elements of your case can help us identify the prosecution’s weaknesses.
  • Develop your defense strategy. Federal laws apply to healthcare billing and procedures. We use our knowledge of the system to your advantage. Our firm can examine all potential strategies to select the most suitable option for your defense. Whether your case requires challenging the prosecution’s evidence or negotiating a plea deal, we can find the ideal solution.
  • Protect your rights and reputation. With your reputation on the line, we can ensure the prosecution treats you fairly. You deserve to present your side of the story. We can help protect your rights and seek to prevent damage to your reputation.
  • Advocate for your ideal outcome. We want you to be successful. When we fight for you, we strive for the outcome that will benefit your livelihood. Whether we can seek dismissal or keep you out of jail, we can fight for the optimal outcome.

Get Help With Your HealthCare Fraud Case Today

Facing a healthcare fraud case can be stressful. The possible ramifications of a conviction can be devastating to your finances, your reputation, and your family. You should not attempt to face this white-collar crime charge alone. Depending on your case details, you may face enormous fines and potentially jail time. Contact the W. James Payne Law Firm today for a confidential consultation.