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California Overbilling Defense Lawyer

As a physician, you got into medicine to treat people who were suffering and improve the quality of their lives. It’s only after you get a successful practice up and running that you realize how complex and daunting the billing and reimbursement side of the business – and it is a business – can be. Hiring qualified, competent staff to handle your billing is essential, but you can’t just leave it all to them and hope they are doing everything right while you attend to the medical side of things. As the owner of the practice, you are the one held responsible for making sure all laws and regulations are being complied with, and it’s your finances, your medical license, and your personal freedom that are at stake when mistakes get made.

Overbilling and coding errors can land you in hot water with the Department of Justice (DOJ), the Health and Human Services Office of the Inspector-General (HHS-OIG), the Centers for Medicare and Medicaid Services (CMS), Medi-Cal and other agencies, not to mention civil lawsuits under the federal False Claims Act (FCA) and other laws. Whether these errors are due to innocent mistakes, negligence, or intentional acts perpetrated by someone at your practice, you need to make sure you are represented by a skilled and knowledgeable healthcare defense attorney who is dedicated to protecting your rights, ensuring fair treatment, and helping you get the best result possible given your situation. These are all qualities you’ll find at the Law Offices of Art Kalantar in Beverly Hills, serving healthcare clients in Los Angeles, Southern California, and statewide. Call our experienced California overbilling defense attorney today for a free case evaluation and immediate assistance in your matter.

Examples of Overbilling and Medicare Fraud

Overbilling can occur in many different ways. Billing departments bill insurance companies and government payers like Medicare and Medicaid (Medi-Cal) through an elaborate coding system that is always being revised and updated, with new codes being added, old codes being deleted, and existing codes getting changed and reclassified all the time. Submitting the wrong code can lead to overbilling. It is a problem that exists in a small percentage of the countless billing transactions that go on, but the overall dollar effect is large enough that government agencies will go to great lengths to launch an investigation and prosecute someone they suspect of overbilling. When overbilling is done for the purpose of defrauding the government and getting more money than the medical practice is entitled to, the owner of the practice can be subject to criminal penalties including hugely expensive fines, years in prison, and the loss of their medical license. Assistance from an experienced overbilling defense attorney can help you avoid the worst consequences of a healthcare fraud conviction, even helping you avoid any conviction or penalty at all. Make sure your first call after notice of an OIG investigation is to an experienced healthcare defense attorney who can help you.

Examples of overbilling that can lead to a prosecution for Medicare fraud include:

  • Billing for the wrong procedure
  • Charging at the wrong rate
  • Billing for unnecessary services
  • Billing for services that weren’t performed
  • Unbundling
  • Upcoding

Committing unintentional errors might not keep you from being investigated or prosecuted, but you shouldn’t be criminally punished for mistakes when there was no intent to defraud. Medicare might not want to cover a test, procedure or equipment you billed for because they deem it unnecessary. They are interested in cost containment while you are interested in patient health. What the government says is overbilling might in fact reflect a high and appropriate commitment to quality of care. A skilled healthcare lawyer who is knowledgeable about the law will know how to bring out the facts necessary to provide a strong and effective defense against charges of overbilling.

It’s not only government investigations you have to worry about. Your own billing department employee might suspect someone is overbilling Medicare in an attempt to make more money in an unscrupulous manner, leading them to file a False Claims Act lawsuit. The Law Offices of Art Kalantar can conduct a Medicare and Medi-Cal audit to make sure your billing is correct and fix errors before they become an issue.

Call the Law Offices of Art Kalantar for Overbilling Defense in California

If you are under investigation or facing charges for overbilling in California, call the Law Offices of Art Kalantar for a free case evaluation and immediate assistance. We’ll work to resolve the matter at the earliest possible stage and in the way that is most favorable to you. Call our experienced California overbilling defense lawyer today at 310-773-0001.

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