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.

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.

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.

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.

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.