Atlanta Healthcare Fraud Attorney
Types of Healthcare Fraud in Georgia
- Fraudulent Billing - Fraudulent billing occurs when a healthcare provider sends a bill for medical services that were not actually provided. For example, a patient might receive a bill after no medical service was rendered or after a service was rendered, but descried differently on the claim for payment. Sometimes, fraudulent billing occurs when the care provider charges the patient twice for the same medical service.
- Upcoding - Upcoding occurs when a care provider submits a bill with the wrong service code. For example, a follow-up appointment might be upcoded to a comprehensive office visit. Comprehensive visits cost more than follow-up appointments. Thus, the care provider would receive extra payment for the service rendered. Other types of upcoding involve: billing group therapy as individual therapy, billing unilateral procedures as bilateral procedures, and billing a half-hour session as a 50+ minute session.
- Unbundling - This scheme involves billing a patient with multiple bills to collect the highest-possible reimbursement for tests and other medical services. If the medical provider could have billed the tests, etc. as one procedure for less money, he/she might be accused of unbundling if the bill is sent in fragments. For instance: some lab tests can be ordered individual or in a panel. Doctors that bill them individually to collect more money may be guilty of unbundling.
- Excessive Medical Service - Sometimes, healthcare providers try to trick patients into thinking that they need more medical attention than is actually necessary. For instance, a doctor might prescribe dialing visits when monthly or weekly visits are more appropriate for the patient's needs. A medical supply company might bill a nursing home for 30 wound care kits every week when the facility only needs one per day.
- Kickbacks - The term "kickback" refers to a specific type of healthcare fraud. Kickbacks occur when a healthcare provider offers or accepts payment in exchange for patient referral when the patient's medical needs will be handled by Medicare or Medicaid. For instance, a doctor might accept $100 for every patient that he/she refers to a specific laboratory for testing. Kickbacks are usually paid in cash, paid vacations, jewelry, or other valuables and are determined by a percentage of the Medicare/Medicaid coverage.
Facing any criminal allegation is a serious challenge. At Weintraub & Alper Legal you don't have to face this accusation alone. Our law firm is dedicated to providing high-quality legal representation in Atlanta and the surrounding areas. At the firm, we handle a wide variety of criminal defense practice areas – including healthcare fraud. Simply put, healthcare fraud refers to the intentional falsification of any healthcare transaction. Healthcare fraud can be committed by a provider, employer group, employee, or healthcare member. Persons might commit healthcare fraud by billing for services that were not provided or performing unnecessary medical services to collect payment.
Healthcare Fraud in the United States
According to the Federal bureau of Investigation (FBI), healthcare fraud costs the United States approximately $80 billion every year. The U.S. spends more than $2.7 trillion on healthcare every year. Unfortunately, the cost of healthcare is outpacing inflation – making healthcare fraud a growing threat to the integrity of the medical industry across the country. The FBI reports that recent cases of healthcare fraud demonstrate a rising trend among healthcare providers: a willingness to risk patient harm in their schemes.
The FBI is dedicated to stopping healthcare fraud and protecting medical patients across the country. With jurisdiction in private and federal insurance programs, the FBI has a far-reaching influence in the healthcare industry and uses undercover operations and coordinated initiatives to disband harmful healthcare fraud schemes. Not every healthcare fraud suspect is a criminal, though. In fact, overzealous initiatives and operations can easily lead the FBI to accuse innocent persons of healthcare fraud.
If you've been wrongly accused of healthcare fraud, contact Weintraub & Alper Legal today. We have more than 55 years of combined legal experience fighting for clients like you: let us put this experience to work for your healthcare fraud defense case! Our team can create an effective and aggressive defense strategy to give you the best chance of a favorable case outcome. Contact our office today to retain the aggressive legal representation you need.
Healthcare Fraud in the Future
The FBI predicts that healthcare fraud will continue to grow in popularity as advanced medical treatment allows people to live longer. As people live longer, long-term and short-term medical treatment will be utilized more, creating more and more opportunities for healthcare fraud. According to the FBI, fraudulent healthcare schemes will become more complicated in the future. Because of this, the government is prepared to implement aggressive investigations against suspected healthcare fraud.
The FBI reports 2,690 healthcare fraud investigations in 2011. These investigations resulted in 1,676 indictments and 736 criminal convictions. As the healthcare industry continues to expand, so will the FBI's aggressive pursuit of fraudulent healthcare schemes. Since 2008, the number of pending healthcare cases has grown from 2,434 to 2,690. If you are facing allegations of healthcare fraud, contact Weintraub & Alper Legal today. Fraud is a serious criminal accusation; don't risk your future, freedom, career, and wellbeing by handling an accusation alone.
Call our team of Atlanta healthcare fraud lawyers today for the outstanding legal service your case requires. The sooner we hear from you, the faster our team can help, so take the first step toward a secure legal future and contact us today.