Coding Errors

Procedures for billing Medicare and other insurers are an ever-changing landscape. There are numerous different billing codes for procedures that are often difficult to keep track of, and coding errors or other mistakes may actually be treated as a case of fraud by the federal government. Healthcare providers—whether individual practitioners, sizeable medical firms, or large hospitals—all face the risk of being charged with medical coding fraud, potentially resulting in criminal penalties, civil liability, and other costly consequences.

If your business is accused of billing fraud, it may be wise to consult a knowledgeable Michigan coding errors lawyer as soon as possible to learn how to protect your rights. A healthcare fraud attorney with experience defending coding fraud cases can help you work toward a positive outcome.

It may seem difficult to believe that a mistake in billing codes could provide grounds for allegations of medical coding fraud. It should be noted that if the federal government believes a practitioner is intentionally filing false claims with Medicare, Medicaid or other insurers, coding errors could lead to criminal charges.

It is still important to remember that prosecutors alleging fraud must prove that conduct was actually fraudulent. As such, a seasoned coding errors attorney in Michigan can exploit weaknesses in evidence regarding fraudulent conduct.

With such a complex system of coding, the potential for billing errors is virtually limitless. However, there are several specific types of coding mistakes or other errors that frequently lead to criminal charges or accusations of fraud. As a knowledgeable Michigan coding errors attorney could explain, these include:

• Coding for a diagnosis that has not been confirmed
• Billing patients for more services than they need
• Billing patients for services never performed
• Billing patients for services more expensive and complicated than the services provided, which is referred to as upcoding
• Billing separately for services that should be bundled together, which is referred to as unbundling

Whether coding errors were committed by staff in the practitioner's office or by a billing service, the practitioner may be held liable. As an example, a person may not have realized that a series of treatments or tests should have been bundled together and may have failed to do so.

Since the amount billed in this scenario might be higher when the services are billed individually, such conduct could appear to be deliberately fraudulent when it may be a simple procedural error. Even if the practitioner never receives additional payments, the billing errors alone are sufficient to support charges of fraud. No matter which type of coding error you were accused of, a skilled Michigan lawyer could review your case and build your case.

When billing fraud is alleged in Michigan, a case may involve several different federal or state laws. Since 42 U.S.C. 1320a-7b sets forth criminal penalties for actions relating to Medicare and other federal healthcare programs, and since numerous healthcare claims involve federally funded insurance, this statute frequently comes into play in coding error cases.

Those convicted of fraudulent conduct under this statute may be guilty of a felony punishable by a maximum fine of $100,000, and imprisonment of up to ten years. Billing errors could also result in actions under the Federal False Claims Act—codified in 31 U.S.C. §3729—which may be brought by the government or by private individuals as "whistleblowers" acting to expose fraud against the government.

To be convicted of fraudulent activity in most situations, the government must demonstrate that wrongful actions were taken willfully and knowingly. Consequently, if federal fraud charges stem from coding errors that were truly mistakes with no intent to reap any fraudulent benefits, it could be possible to have the charges dismissed.

Since intent can be a tricky matter to prove or disprove, those who are facing charges involving allegations of medical billing fraud are advised to work with an experienced Michigan coding errors lawyer who understands how to build a successful defense strategy. For a consultation to learn how a knowledgeable defense attorney can investigate and advocate on your behalf, call now.