Super Lawyers
Justia Lawyer Rating
Best Lawyers
The Best Lawyers in America
Avvo Clients' Choice
Avvo Rating 10.0
National College for DUI Defense
National Collage for DUI Defense
American Council Of Second Amendment Lawyers

Billing Fraud

Medical billing fraud is currently a rising issue in Michigan, and federal prosecutors frequently step in when the fraud alleged involves a hospital or sizeable medical practice. While medical billing errors often stem from honest mistakes, they may still be charged as criminal offenses.

Penalties for billing fraud can be severe and include the potential for incarceration and substantial fines. If you are under investigation for billing fraud, it is advisable to consult a Michigan billing fraud lawyer even if charges have not yet been filed.

An experienced healthcare fraud attorney familiar with billing fraud situations can explain the potential ramifications, start building a defensive strategy, and could advocate on your behalf to work toward a positive outcome. They can also help to establish a system for ensuring compliance with federal billing regulations.

Potential Areas of Concern

Insurance billing requirements for medical offices have become as complicated as the practice of medicine itself. Potential issues that could subject a medical practice to legal liability for billing fraud include:

  • Upcoding
  • Unbundling
  • Anti-Kickback Violations
  • Stark Law violations
  • False Claim Act issues
  • Prescription fraud
  • Falsifying records or results
  • Coding errors

In some instances, billing errors—or even deliberate fraud—may be committed by a third-party billing service. A seasoned billing fraud lawyer in Michigan can assist with asserting that a provider should not be held liable for the unknown actions of outside billing entities.

The False Claims Act

While there are numerous federal and Michigan state statutes on the books that prohibit various practices associated with medical billing fraud, the federal False Claims Act is one of the laws most commonly used to address allegations of fraud. Codified in 31 U.S.C. §3729, the Act subjects individuals and organizations to liability for knowingly presenting a fraudulent claim for payment by the government or knowingly using a false record that is material to a fraudulent claim, as well as for other practices.

While this law applies to bills in all types of situations and is frequently used with government defense contractors, it is also frequently applied in medical billing fraud cases since numerous providers seek payment through Medicare, Medicaid, and other federal programs. As a knowledgeable Michigan billing fraud attorney could explain, those found liable for billing fraud in a False Claims Act case may be required to pay damages equal to three times the amount of loss suffered by the government. The government may also impose an additional fine of up to $10,000.

Criminal Liability for Billing Fraud

Federal prosecutors may also treat billing fraud as a criminal violation of 18 U.S.C. §1347, which defines and prohibits healthcare fraud. Executing or even attempting to execute a "scheme" to defraud a healthcare program or fraudulently obtain funds from a healthcare benefit program could subject a provider to criminal penalties under this statute.

Those found guilty may be given a maximum sentence of ten years in prison, or much longer if the violation results in serious injury or death. A conviction also carries the potential for a hefty fine. A skilled Michigan attorney could build a defense case to fight against any penalties for billing fraud you may face.

Contact a Michigan Billing Fraud Attorney

Since billing fraud may be penalized as severely as a violent felony, it is usually wise to take all available steps to prevent actions that could be interpreted as fraudulent and to address any allegations of fraud promptly. A Michigan billing fraud lawyer can assist with setting up a system for compliance as well as defending against any allegations that have been made or may be forthcoming.

A proactive stance toward billing fraud could make a tremendous difference in the outcome of a case. To learn how an experienced billing fraud attorney may be able to assist in your situation, call for a consultation.

Client Reviews
★★★★★
Patrick Barone is the ONLY choice for DUI defense. He was realistic from the start and made it a point to look at my case before taking my money. As a business owner, when I think of attorneys, I think of the "shark infested waters. Patrick is a shark alright, but his prey is not the client; it's justice for his client. Ten stars Patrick!! Chris F.
★★★★★
Attorney Patrick Barone was very helpful and helped me understand the charge and sentence absolutely clearly. He also guided me through step by step helping me form a statement. His instructions were clear and detailed. It was obvious he cared about me understanding every important detail within my case. I would absolutely recommend this defense firm to anyone in need. Aaron B.
★★★★★
The Barone Defense Firm is the firm I recommend. They are truly concerned about the person, not just the legal issue, but the person as well. They are the most knowledgeable defense firm that I am aware of, having actually written the book on DWI Defense. If you are faced with a DWI you will not find a more professional and skilled law firm. But, most importantly, they care about how the accused individual recovers his or her life when the case is complete. Very remarkable group of lawyers. William H.