Health Insurance Fraud Defense
Health Insurance and Medicaid Fraud Attorney
According to the U.S. Government Accountability Office, about $1 out of every $7 to Medicare is lost due to insurance fraud and abuse. As a whole, insurance fraud may involve up to $100 billion in stolen funds each year. Because of the widespread nature of the problem, charges of fraud and abuse against physicians and other health care providers can have serious consequences. If you have been charged with health insurance fraud and now face the risk of losing your professional license, the Texas professional license defense lawyers at the Leichter Law Firm have the knowledge and experience you need to help you build the strongest defense possible. Contact our offices today at 512-495-9995 to discuss your situation.Examples of Health Insurance Fraud
The most commonly-reported type of health insurance fraud is a false claims scheme. Any of the following actions, if performed fraudulently, could be considered health insurance fraud:- Ordering tests or performing services that are unnecessary
- Billing for services or procedures that were not rendered
- Misrepresenting a condition or a service
- Duplicating charges
- Receiving kickbacks or other benefits for referrals
How Far Back Can Medicaid Audits Go?
Individual states determine how much Medicaid will be paid, usually on a contingency fee basis. Claims can be review up to three years after the date they were filed.
What Does a Medicaid Fraud Attorney Do?
A Medicaid fraud attorney assists physicians and healthcare professionals when a complaint has been filed against them, whether by a patient, whistleblower, or another internal agency discrepancy.
Who Investigates Medicaid Fraud?
Medicaid Fraud Control Units, or MFCUs investigate and also prosecute Medicaid fraud on the provider’s side. They also prosecute patient abuse or neglect in health care facilities and board and care institutions.
How Far Back Can Medicaid Audits Go?
Individual states determine how much Medicaid will be paid, usually on a contingency fee basis. Claims can be review up to three years after the date they were filed.
What Triggers a Medicare Audit?
MFCUs use data and statistics that recognize over and under coding incidents. If your practice falls outside of what they consider “normal”, you are more than likely to receive a Medicare audit. Also, excessive modifiers can also increase your risk. Another common reason for Medicaid audits include patient complaints and disgruntled employees.
What Does Medicaid Look for In An Audit?
According to CMS, CERT audits use a valid random sample of claims. Auditors review the selected claims to determine whether they were paid properly under Medicaid coverage, coding and billing rules. If you’re being audited by Medicaid or Medicare, or any health insurance agency, for that matter, you’ll want to hire a health insurance fraud attorney.
Is Medicaid Fraud a Felony?
Medicaid fraud prosecuted at the state level can be a felony or misdemeanor. It depends on the state law. In Texas, healthcare fraud can range from misdemeanor to a felony offense.
Get in Touch
Office Locations
1602 E 7th St
Austin, TX 78702
Phone: (512) 495-9995
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3700 N Main St
Houston, TX 77009
Phone: (713) 714-2446
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214 N 16th St #128
McAllen, TX 78501
Phone: (956) 205-0884
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Hire a Medicaid Fraud Attorney for Audits and Investigations
Medicaid audits are conducted by state agencies for the purposes of determining compliance, overpayments, and to look for evidence of Medicaid fraud on behalf of a physician. Often, Medicaid audits are conducted in response to a complaint from a patient, whistleblower or Medicaid plan. Auditors may conduct an onsite audit or an offsite audit, called a desk audit. They will use several fraud and overpayment detection methods, including but not limited to: data mining, evaluating claims against similar providers in your region, and if they suspect fraud, they’ll refer to Medicaid Fraud Control Unit (MFCU). These audits cam result in tens of thousands of dollars in overpayment demands, false claim charges and anti-kickbacks. So, we advise you seek assistance from a Medicaid fraud attorney if you have reason to believe you may be subject to a Medicaid audit or investigation.Common Types of Medicaid Fraud
- False invoicing
- Billing for un-provided services or equipment
- Overutilization of certain medical procedures or services
- Billing unbundled services
Possible Medicaid Fraud Outcomes
- Criminal charges
- Licensing Action
- Expulsion from the Medicare or Medicaid program
- Loss of staff privileges
- Inability to collect outstanding invoices
- Fines
