Healthcare fraud and abuse occur in nearly every type of healthcare setting and from every different type of provider. Fraud is very common among state and federal health programs like Medicaid and Medicare, but it also occurs among private healthcare corporations and even medical supply and equipment companies. The National Health Care Anti-Fraud Association has conservatively estimated that the annual national cost of healthcare fraud in the U.S. is about $68 billion. Healthcare fraud is also a federal criminal offense under the Health Insurance Portability and Accountability Act, or HIPAA. However, those guilty of healthcare fraud are subject to penalties from both the state and federal government.
Unfortunately, fraudulent billing is not at all uncommon in healthcare. A healthcare provider may order and/or bill a patient for services that are not truly necessary, like excessive testing or similar. Providers, hospitals, nursing homes or medical equipment companies may bill for services or equipment that was never given or furnished, and records may be falsified or created in order to make this look legitimate. This may even happen unintentionally. For example, if a physician signs off a chart with orders on it that are never carried out, the patient may be billed and the physician may be unaware until much later. That’s one reason why, if you’ve been accused of healthcare fraud, the smart thing to do is to hire an experienced healthcare fraud attorney.
Upcoding and Unbundling
Medical services are billed by using a system of codes. Upcoding is a method of fraud that occurs when the biller assigns a code to a medical service that reflects a more expensive service than the one that was actually given. Also, some billing codes are comprehensive codes that cover a package of services for a certain fee. Unbundling occurs when a biller intentionally assigns individual codes for each service that should be in a package, increasing the total fees. Medical billers and coders are taught to be ethical during their training, but upcoding and unbundling still do occur.
Call to Schedule a Free Consultation With a Healthcare Fraud Attorney Today
If you are facing a charge of healthcare fraud, call to schedule a free consultation with a healthcare fraud attorney today. The experienced legal experts at the Law Offices of John D. Kirby will thoroughly evaluate your case and build you a strong defense for the best possible outcome. Call us at 619-557-0100 to schedule a legal consultation to discuss your charges. Our expert team will give you the legal advice you can trust.