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Grand Rapids Health Care Fraud Defense Lawyer

There are various types of health care fraud, which are schemes undertaken by doctors and other health care providers designed to defraud federal health care programs such as Medicare, Medicaid, or Tricare through false or fraudulent claims for compensation. The federal government has been relentless in pursuing cases of suspected health care fraud, and several federal laws provide severe sanctions for violating them.

In some cases, innocent errors in claims, billing, and coding can lead to the U.S. government taking civil or criminal action against doctors and medical care providers for violations of the federal laws that govern these claims for payment. The government typically must show proof of intent to defraud a health insurance program to proceed with criminal charges.

A Grand Rapids health care fraud defense lawyer may be your most effective means of fighting back against allegations of health care fraud. A skilled fraud attorney can be invaluable in building a strong medical fraud defense.

Billing Errors and Health Care Fraud

Billing errors in filing claims with federal health care programs are a common source of accusations of health care fraud. Billing fraud may include the following unlawful actions:

  • Billing for services or equipment that patients never received
  • Filing claims for non-reimbursable services and patients not covered by federal benefits programs
  • Submitting duplicate claims
  • Filing claims for medically unnecessary services

There are also various rules and regulations that health care providers must follow to remain eligible to receive payments from these federally-funded programs. A health care fraud defense lawyer in Grand Rapids can help ensure that all billing practices are in line with relevant federal laws and regulations.

Failing to submit claims with correct billing may violate federal laws, including the False Claims Act, which prevents health care services providers from making false statements on claims submitted to federal health care plans for payment. Billing errors also may violate 18 U.S.C. §1347, which criminalizes any intentional action to defraud a federally-funded health care benefit program or accept payment based on pretenses or misrepresentations.

Health Care Fraud and Falsified Records

Falsifying patient, medical, and financial records could also constitute health care fraud. Doctors and health care providers may falsify patient records to file claims that patients never received or claims on behalf of patients that do not exist. Likewise, hospice and home health care services providers might forge physician certifications of medical necessity or falsify records to indicate that they provided certain services that they actually did not.

These are just a few examples of the types of health care fraud that may involve falsified records. Given their potential severity, these fraudulent actions could have both civil and criminal consequences. A Grand Rapids lawyer may be able to assist doctors and other medical providers with health care fraud defense if they are facing allegations of falsified records or claims.

Kickbacks and Physician Self-Referrals

Another type of health care fraud involves improper remuneration in exchange for referrals for services that are compensable under federal health care benefits programs. 42 U.S.C. §1395nn, also known as the Stark Law, prohibits physicians from referring their patients to entities or health care providers with whom they or their immediate family members have an ownership or financial interest.

The federal Anti-Kickback Statute also addresses improper compensation in exchange for referrals for services eligible for Medicare, Medicaid, or Tricare payments. 42 U.S.C. §1320a-7b makes it a felony offense to purposely pay or receive compensation to obtain business referrals for services reimbursable under one or more of these federal health benefits programs.

Call a Grand Rapids Health Care Fraud Defense Attorney for Assistance

Allegations of federal health care fraud can have severe consequences on both civil and criminal levels. Possible penalties may include incarceration, civil fines, and treble damages, or triple the value of the falsified claims submitted to the federal government.

The stakes are high in federal health care fraud cases since the federal government has a vested interest in investigating and recouping compensation paid out according to false or fraudulent claims. To potentially avoid the severe repercussions that a finding of fraudulent behavior can bring about, you should not hesitate to contact a Grand Rapids health care fraud defense lawyer right away if you are facing such allegations.

Having legal counsel at your side during any civil or criminal proceedings may be essential to developing the most robust medical fraud defense possible in your case. To start working towards a positive outcome in your situation, call today to schedule a consultation.