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California Healthcare Lawyer for Billing Fraud Defense

Billing fraud is one of the most common predicate offenses for the prosecution of healthcare organizations under the False Claims Act. Billing fraud covers a wide range of conduct resulting in patients, insurance companies, or government health insurance providers paying more than they should for the services rendered.

Medical billing fraud is an incredibly serious allegation, and medical offices or healthcare professionals facing investigation for billing fraud need skilled and effective counsel on their side as soon as possible. Failure to respond to billing fraud charges swiftly and appropriately can lead to hefty fines, reputational damage, sanctions to professional licenses, and possible criminal prosecution. Without the best legal help on your side, billing fraud charges can entirely derail your healthcare enterprise.

Law Offices of Art Kalantar and our billing fraud defense lawyers are standing by to protect you and your company from allegations of fraud and abuse. We have unparalleled knowledge of healthcare laws and how they pertain to the healthcare industry. We have decades of experience in the healthcare law industry and have spent years helping healthcare professionals protect their businesses, their licenses, and their freedom. We’ll fight for your rights and present the strongest defenses available to any billing fraud accusations you and your enterprise may be facing.

Common Forms of Billing Fraud

Medical billing fraud can take many different forms. At base, billing fraud occurs whenever a medical care provider bills a payer more than what is appropriate for whatever services were actually provided. Some of the more common billing fraud schemes include:

  • Services were never performed. Some healthcare organizations bill Medicare or other insurance providers for services they never actually perform, such as X-rays, physical therapy, or blood tests. Some providers even pay patients to go along with the scheme.

  • Upcoding occurs when a healthcare provider performs one service but then charges for another, more expensive service. Upcoding may also occur when a healthcare provider bills the payer as if a more expensive person was involved with the consultation or procedure–such as billing for a physician consultation when a consultation was conducted by a nurse practitioner.

  • Unnecessary services. Healthcare organizations that order unnecessary medical tests or perform procedures that are not medically necessary to treat a patient may be charged with fraud and fraud-related offenses.

  • Double billing. Healthcare providers who charge twice for the same procedure may be charged with billing fraud.

  • Any form of overcharging may constitute billing fraud. For example, if a provider charges certain payers more for the same procedure than they charge other payers (e.g., charging Medicare or Medi-Cal more than private payers), they may face allegations of overcharging.

  • Unbundling occurs when a healthcare provider separates the constituent parts of a medical procedure and bills each step as a separate charge in order to charge more overall.

Seasoned Legal Advice and Trusted Representation for Billing Fraud Defense

Billing fraud is a serious allegation that can have profound consequences for a medical officer. Depending upon the nature of the conduct and the parties allegedly defrauded, billing fraud can lead to healthcare fraud charges, False Claims Act charges, and other forms of prosecution. To protect your business, your finances, and, potentially, your freedom, call a skilled billing fraud defense lawyer. Your license, your practice, your assets, and your liberty may be at stake. The Law Offices of Art Kalantar and our medical billing fraud defense lawyer are ready to provide you with comprehensive, effective legal advice and representation for your healthcare law matters in Los Angeles and throughout Southern California.

Call 310-773-0001 at any time to request a free case evaluation with the Law Offices of Art Kalantar in Beverly Hills.

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