Reasons to Hire a Medicare Fraud Attorney

If you operate a healthcare practice, you know just how many laws, regulations, governmental and nongovernmental regulatory bodies, and other concerns you have to address on top of the already-Herculean task of running a medical business. The last thing you need is a government investigation concerning fraud allegations. Below, the seasoned healthcare law and fraud defense attorney at the Law Offices of Art Kalantar discusses the important services that a California Medicare fraud attorney can provide in protecting your practice.

Evaluate Your Compliance Policies and Procedures

Protecting against fraud allegations requires taking proper proactive measures. Often, conduct that might give rise to fraud allegations or other regulatory compliance issues arises simply because of poor training and billing practices, inefficient workflows, lack of written policy manuals, and other inefficiencies.

A Medicare fraud attorney can help you draft, explain, implement, maintain, and update your compliance practices, and develop training protocols for new hires and existing employees to ensure that they are up to speed on all relevant laws, regulations, billing codes, and other important items.

Identify and Remedy Potential Fraudulent Practices

Medicare fraud can be committed in a variety of ways, many of which do not strike as immediately insidious and intentional as the term “fraud” might imply. Sometimes, such fraud can occur simply as a result of poor billing practices–for example, untrained employees using the wrong billing codes or being improperly trained about bundling codes. A Medicare fraud attorney can audit your existing practices and root out any type of Medicare fraud, and deal with staff who perpetrated any such schemes (wittingly or otherwise) appropriately.

Common types of Medicare fraud your attorney can help you identify or deal with include allegations concerning:

• Submitting bills for services that were never actually provided (“phantom billing”). The patient may or may not be aware of the fraudulent billing. Billing twice for the same single procedure is also a common fraudulent practice.
• Submitting bills for services that were medically unnecessary, such as unnecessary diagnostic testing or frivolous surgeries.
• Upcoding a service. Upcoding occurs when the provider charges Medicare for a service that was more expensive than the service actually provided. This often occurs when a patient sees a nurse and the practice bills as if there was a physician consultation.
• Unbundling a service. Unbundling refers to when a provider submits multiple separate bills to Medicare for services that are meant to be billed as a single service. For example, many lab services will combine three or four different tests. Billing them separately causes Medicare to overpay for the service actually provided.
• Billing non-covered services as a covered service. Not all services provided by a healthcare provider are necessary, covered medical procedures. A practice may face fraud allegations if they, for example, bill nail clipping as hand surgery. Similarly, filing a claim on behalf of a patient not actually eligible for Medicare may constitute fraud.

Defend Against Fraud Allegations and Investigations

The goal of a Medicare fraud attorney is to stop investigations and prosecutions from taking place. However, sometimes fraud does occur, or at least practices are unearthed that appear potentially fraudulent. If you are facing a government investigation for potential Medicare fraud, you need a seasoned Medicare fraud lawyer in your corner as soon as possible to help you respond to government requests, guide your internal (and their external) investigations, and build the strongest defense of your practice, your license, and your career.

Trusted Advice and Effective Representation for Your California Medical Practice

For help with matters involving healthcare fraud allegations, healthcare regulatory compliance, auditing, employment disputes, mergers and acquisitions, business disputes, licensing, or any other California healthcare law matters, contact the Law Offices of Art Kalantar in Los Angeles or California statewide at 310-773-0001.