Super Lawyers
Justia Lawyer Rating
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
Avvo Clients Choice Award
Avvo Rating
Trial Lawyers University
Best Lawyers
James Publishing Author
Super Lawyers
Trial Lawyers College

Grand Rapids Coding Errors Lawyer

To bill federal medical benefits programs for reimbursement, health care providers must complete extensive claims that require a great deal of intensive paperwork. This includes assigning the correct billing codes to each claim. When a provider utilizes incorrect billing codes, allegations of federal health care fraud may arise even if using the wrong codes was inadvertent or unintentional. If you are facing charges of fraudulent billing practices, you may want to consider contacting a Grand Rapids coding errors lawyer for advice.

Various types of coding errors in claims for reimbursement by medical providers can lead to federal prosecution under the FCA. From just using the wrong code to sophisticated coding errors schemes, medical providers may be liable both civilly and criminally if they receive payments from federal benefits programs in error. These programs include Medicare, Medicaid, or Tricare. If you are facing federal civil or criminal charges, a seasoned health care fraud attorney can help.

Prosecution for Coding Errors in Grand Rapids

Billing and coding errors are one of the most common types of federal health care fraud. This has led to many prosecutions—primarily under the False Claims Act (FCA)—of medical providers of all sizes and from all areas of the United States.

The FCA contains a broad prohibition on making any false statements or misrepresentations of fact to obtain payments from a federal health care benefits program to which they are not entitled. A claim for reimbursement based on a coding error qualifies as a “false claim” for the FCA.

The civil enforcement mechanisms in the FCA do not require any evidence of ill intent. Consequently, a purely mistaken coding error still constitutes fraud against the government and triggers the civil liability provisions of the FCA, meaning that the provider would have to return any reimbursements received as a result of coding errors.

If the Department of Justice (DOJ) finds evidence of intentional miscoding of claims for medical services or equipment, it can also pursue criminal charges against the medical provider. This may result in high fines and penalties, as well as a sentence of incarceration in federal prison. In this situation, consulting with a coding errors lawyer in Grand Rapids may be useful.

Common Examples of Coding Errors

One typical example of a coding error is upcoding. In this situation, providers routinely submit codes for items or services that are reimbursable at higher rates than the items or services provided. A similar type of error is unbundling, through which providers separate claims for services in violation of guidelines that require certain services and supplies to be bundled and claimed at a lower reimbursement rate.

Another related coding error is adding modifiers to billing codes. The Centers for Medicare and Medicaid Services (CMS) permit the addition of modifiers only in very isolated and specific situations. When providers add inappropriate modifiers to billing codes to get higher reimbursement rates, they commit fraud in the eyes of the U.S. government. For more information, contact a knowledgeable defense lawyer.

Civil and Criminal Penalties for Grand Rapids Coding Errors

The FCA permits the DOJ to pursue civil or criminal penalties against health care providers that violate its terms. When there are no allegations of intent to commit fraud, health care providers are more likely to face civil penalties. These penalties may include thousands of dollars in fines for each false claim, treble—or triple—damages, and reimbursement of the value of the false claims.

If the DOJ finds evidence of intent on the part of a medical provider to submit improperly coded claims designed to defraud a federal benefits program, criminal prosecution can occur. Potential fines may result in hundreds of thousands of dollars in fines and years of incarceration for each false claim. A qualified coding errors attorney in Grand Rapids may be able to help with either type of charge.

Work With a Grand Rapids Coding Errors Attorney Today

The ramifications of either civil or criminal sanctions for improperly coded claims seeking reimbursement from federal benefits programs can be severe. Incarceration, loss of medical licenses and hospital privileges, and non-payment of future claims all may result, in conjunction with thousands in fines and penalties.

A Grand Rapids coding errors lawyer can help defend individuals against accusations of wrongdoing and work to minimize the impact of these accusations on your personal and professional life. Call today to learn more.

Call Today! FREE Consultation Lawyer and Receive Immediate Attention for Your Criminal Law Case Patrick T. Barone is a Michigan Super Lawyer, who has maintained continuous top attorney ratings since 2007. In addition, the Michigan native is the author of multiple books on OWI, DUI and criminal law. The OUIL attorney near me has lectured at over 80 legal seminars all over America. He leads Barone Defense Firm in providing aggressive legal warriors for each client's criminal case.

Contact us 24 hours a day at our law firm’s easy to remember toll-free number, 1-877-ALL-MICH or 877-255-6424, for a free criminal case review. The Michigan attorneys near me at Barone Defense Firm travel the entire Great Lakes State, to help citizens in legal trouble in Michigan for alleged criminal law violations.

For your FREE lawyer consultation, call today to learn how to protect yourself from a possible unwarranted conviction. What do you have to lose, when the free legal advice with our litigation team’s criminal lawyers near me can answer many tough questions?

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.