Charging for Services Never Performed
Over 90% of the U.S. population is covered by insurance, including private insurance companies as well as government payers such as Medicare and Medicaid (Medi-Cal in California). That means that for most office visits and other healthcare services, the patient only pays a fraction of the service as a co-payment; the bulk of the bill is paid for by the insurance company or government. Providers bill those payers by submitting claims for reimbursement that identify the patient, date of service, and type of service performed, which is coded according to a standardized set of codes known as Current Procedural Terminology (CPT) codes.
Payers like Medicare in large part rely on the information submitted to them by the healthcare provider. When a doctor or clinic sends in a claim with the pertinent information, they are certifying that the claim they are submitting is true and complete. Medicare reviews these claims and has systems in place to catch errors such as duplicate billing, unbundling, or upcoding, but it cannot inspect every claim that comes through the system.
Unscrupulous providers could take advantage of this system and bill Medicare for services that were never performed. If the government gets wind of this through a whistleblower’s False Claims Act lawsuit or by uncovering irregularities in the provider’s billings, agencies like the Department of Justice can launch comprehensive investigations and enforcement actions that result in convictions, fines, loss of licensure, and prison terms for the guilty parties. Unfortunately, many people who made innocent mistakes or even did nothing wrong at all can get swept up in these prosecutions as well.
Whatever level of culpability you may or may not have, you are entitled to defend yourself against charges brought by the government. You have constitutional rights designed to ensure fair treatment, and you may additionally have one or more defenses that absolve you of liability or guilt for the offenses charged. One of your most important rights is the right to an attorney who can advise you and represent you, arguing on your behalf and working to get you the best possible outcome in your case. At the Law Offices of Art Kalantar, you’ll find an experienced and dedicated California healthcare law attorney devoted to protecting your rights and achieving a positive result when you’ve been charged with billing for services never performed. Call our experienced California healthcare fraud defense lawyer today for a free case evaluation and practical advice on how to proceed in a way that protects your rights and positions you for a favorable conclusion to your case.
Examples of Charging for Services Never Performed
Healthcare providers have been found guilty of charging for services never performed in several different ways, including submitting claims for reimbursement on non-existent patients. More often, though, the patient might be real, but the services are invented or inflated. For instance, a clinic might see a patient for an initial visit but charge Medicare not only for that actual visit but also for several follow-ups that did not occur. Or the provider might bill for testing, services, prescriptions or diagnoses that were never conducted during the appointment. Billing Medicare for expensive durable medical equipment or in-home medical devices that were never provided is another way healthcare professionals could charge Medicare for services that weren’t provided.
A related example includes billing for services that were performed by a different provider at a lower rate, such as billing for services at the doctor’s rate when the service was actually performed by a nurse or physician’s assistant. This is more properly termed “upcoding,” since the service was technically provided. In either case, the provider could be found guilty of Medicare fraud and hit with substantial penalties.
You Need a Strong Defense Against Healthcare Fraud Charges
Because the potential consequences of being found guilty of Medicare fraud are so severe, it’s important to retain the services of an experienced and dedicated healthcare fraud defense attorney with a record of success defending doctors and medical practices in similar situations. It’s possible the government got the facts wrong and is charging you with misconduct you are not guilty of. They could also be going after charges or penalties far out of proportion to any misconduct that did occur. You could have defenses to the charges that excuse the conduct at issue, or the government might not have the evidence needed to prove its case when faced with a skilled and knowledgeable defense lawyer ready to challenge the prosecution. A defense lawyer can also prove invaluable in making sure your rights are respected, that you are treated fairly, and that you get the best outcome available given the circumstances.
Contact the Law Offices of Art Kalantar Today
If you have been charged with billing Medicare for services that weren’t performed, the experienced California healthcare attorney Art Kalantar can advise you and represent you to obtain a positive conclusion of the charges against you. Whether you have been formally charged or are currently the subject of an investigation, it’s imperative to get an attorney on your side immediately to counsel you and act on your behalf as needed. In Los Angeles and statewide, call the experienced California Medicare fraud defense lawyer at the Law Offices of Art Kalantar at 310-773-0001 for a no-cost case evaluation and practical, strategic advice about how best to proceed.