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Defending Medical Fraud Claims

Healthcare fraud is no light matter, costing U.S. companies, investors and taxpayers billions of dollars annually.

Because of this, the federal government is cracking down on medical fraud cases and imposing hefty penalties on convicted offenders.

Examples of healthcare fraud

Any deliberately dishonest act that results in an unauthorized benefit can be considered fraud. Some common forms of medical fraud include the following:

  • Misrepresenting the service provider
  • Misrepresenting the level of service provided
  • Failing to properly document services for which billing takes place
  • Billing patients or insurance companies for unrendered services
  • Charging for products or services that are not medically necessary

It is important to actively combat legitimate instances of fraud by developing strategies to reduce risk, increase trust and ensure the long-term viability of your organization.

Defending yourself against medical fraud charges

To secure a medical fraud conviction, a prosecutor must prove beyond a reasonable doubt that you, the provider of healthcare services, intentionally submitted false or misleading information for financial gain under the pretense of conducting legitimate business.

However, there is no comprehensive guide for medical billing so there could be many reasons for abnormalities or mistakes in the process that do not constitute malicious intent. Therefore, it is often necessary to bring in expert witnesses versed in medical billing and coding to help clarify your version of events.

If you are facing healthcare fraud charges, the worst thing you can do is panic. An attorney well-versed in defending clients against medical fraud claims can help you prepare and defend against such allegations. In some situations, your attorney may be able to provide documentation that clears your name or mitigates your circumstances. In others, you may need to litigate the case to clear your name and retain your license. In either case, an experienced attorney can help you best position yourself to resolve your case and move on with your life.