Over-Billing Can Lead to Health Care Fraud Charges
Miami Criminal Defense Attorney News: As a physician, the management of your business is critical to its success. Unfortunately, medical professionals are busy people that don’t have much time for the nuances of business operations. As a result, their practice is exposed to mismanagement by employees, with potentially disastrous consequences. Billing fraud is rampant in the medical services community. If an investigation by healthcare authorities finds your practice guilty of mishandling billing, you could face arrest and indictment for fraud. You’ll want to hire a Miami criminal defense attorney to represent you in court and clear your practice of wrongdoing.
Fraud in Healthcare
According to the CMS (Centers for Medicare & Medicaid Services), national health costs in the United States totaled more than $3.2 trillion during 2017 or about $10,000 per capita. According to these statistics, healthcare spending is set to grow at a pace of 6.2 percent annually until 2021. This trillion-dollar market comprises of providers, vendors, payers, patients, suppliers, employers, and pharmacists in both private and public practices across all levels of healthcare services.
There are plenty of fraudsters in this trillion-dollar market looking for opportunities to manipulate the system to maximize profits. However, healthcare authorities are well aware of the majority of scams and have taken measures to track down criminals that abuse the system.
An example of fraud in healthcare commonly seen by Miami criminal lawyers is the “up-coding scam.” Every doctor provides a billing code for every service provided to their patients. The scam involves the physician charging the patient for a more expensive procedure than the one delivered.
For instance, a doctor may charge for surgical removal of multiple skin cancer blisters. In reality, they only removed one, thereby boosting the profits of the procedure at the cost of the patient’s healthcare provider.
Trying to shift the blame for billing issues to employee administration errors is fruitless. As the owner of the practice, you are liable for every transaction. If indicted for fraud, you should immediately seek counsel with a criminal defense lawyer in Miami. The charges are serious, and if found guilty of health care fraud, you could lose your medical practitioner’s license.
Complete an Internal Billing Audit
To avoid an investigation, take charge of your business immediately. Hire a forensic accountant to complete an internal billing audit of your practice. This audit may be a costly exercise, but you can write the costs off to your practice expenses during tax season. The results could end up saving your practice while keeping you out of jail.
If you discover billing irregularities due to employee fraud or neglect, contact our Miami criminal defense lawyer for advice on how to handle the situation and mitigate the legal risk to your practice.
To prevent authorities from bringing potential fraud charges against you, familiarize yourself with your billing codes. Compare your billing to other specialists in your medical niche, as any irregularities could bring you to the attention of CMS.
The Dangers of Under-Billing
An internal audit may uncover other issues such as under-billing. In such a case, your practice is losing money. Hire a professional to review your entire billing process and identify any billing issues. A professional will be able to show you how to maximize your billing legally.
What to do if You Are Under Investigation for Healthcare Fraud
The chances are that you didn’t intentionally set out to deceive anyone or commit fraudulent offenses in your practice. Often, doctors get lost in the operations of their day-to-day and neglect the financial area of their business. Doing so could be costly, requiring a criminal defense attorney in Miami to represent you in court. If you find yourself under investigation, contact our criminal defense lawyer immediately and do not speak with law enforcement.
Stroleny Law, P.A handles a variety of criminal law cases, so call now if you have any questions.
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