Defending Against Accusations Of Health Care Fraud And Billing Violations

Health care billing can be notoriously complex. Missteps in this area - whether knowing or not - can lead to serious civil and criminal penalties.

For individuals accused of health care fraud or billing violations, the allegations can not only derail your practice permanently, but permanently damage your professional reputation. Such career-ending allegations could also land you in federal prison.

For group practices, clinics, pharmacies, medical suppliers and other health care institutions, an investigation into fraudulent billing practices can spell doom for the business as a whole. And numerous individuals, from physicians and nurses to billing departments and administrators, may get caught up in the investigatory web of medical billing fraud.

Why A Knowledgeable Defense Team Is So Critical

Health care law is a realm of its own. Medical billing fraud all the more so. Few defense attorneys - even those who handle federal crimes - are familiar with the white collar crimes specific to the health care field, including billing-related fraud cases.

At Roberts Law Group in North Carolina, our lawyers are no strangers to this complex and high-stakes area of law. We can defend you against allegations involving any kind of billing fraud case, including medical and dental billing fraud such as:

  • Receiving illegal kickbacks
  • Billing for services not rendered
  • Billing for supplies/equipment never provided
  • Billing non-covered services as covered
  • Billing for unnecessary services
  • Upcoding
  • Unbundling codes
  • Double-billing
  • Falsifying records
  • Misrepresenting diagnoses
  • Writing fraudulent prescriptions
  • Improperly commingling patient funds in care facilities
  • Waiving deductibles/copayments
  • Utilizing stolen patient/billing info
  • Improper urgent care billing
  • Improper palliative care billing
  • Improper transitional care billing
  • Improper primary care billing
  • Improper home-care billing
  • Medicare fraud involving ambulance billing
  • Other types of medical billing fraud cases

Handle Audits With Care

In many cases, a seemingly benign Medicare audit uncovers evidence of improper billing that culminates in a referral to the HHS Office of the Inspector General or the FBI. Reach out to us for guidance as soon as you receive notice of an audit (or a request for information), particularly ZPIC audits conducted by AdvanceMed. You may be on the brink of a Medicare billing fraud investigation, and the penalties for billing fraud can be severe.

Navigating Multiple Layers Of Applicable Law

Allegations of improper or fraudulent health-care billing frequently involve multiple layers of state and federal law:

  • The federal False Claims Act (and North Carolina's state-law equivalent) establish civil and criminal penalties for those who knowingly defraud the federal government - for example, by submitting false claims to Medicare, Medicaid, TRICARE or the Federal Employee Health Benefits Program.
  • The federal Criminal Health Care Fraud statute makes it a crime to knowingly and willingly defraud any health care benefit program, imposing steep fines and up to a decade in prison.
  • The federal Civil Monetary Penalties Law imposes fines of up to $10,000 plus three times the amount claimed for each Medicare/Medicaid billing violation. Steeper fines apply for anti-kickback violations.
  • An array of serious white collar charges might be leveled against those caught up in the alleged scheme, including conspiracy, mail/wire fraud, money laundering and racketeering.

Often, parallel civil and criminal cases unfold at the same time, jeopardizing defendants' finances and freedoms.

The Far-Reaching Consequences Of Mishandled Investigations And Allegations

Accusations of billing fraud are never something to take lightly. They carry even more weight in the medical industry. Convictions can lead to:

  • A lengthy federal prison sentence
  • Loss of your professional license
  • Exclusion from future participation in government health care programs (including Medicare, Medicaid and NC Health Choice)
  • Revocation of your DEA registration

The sooner you reach out to our defense lawyers, the better. We can help you explore every avenue for avoiding or mitigating these consequences.

Get in touch with us online or by phone at 866-630-2389. Based primarily in Charlotte and Raleigh, we defend health care clients across North Carolina.