Healthcare Fraud and Abuse
Allegations of fraud and abuse are now commonly drawn from over-payment determinations, as well as utilization statistics. Whatever your provider type is, payors are comparing statistical billing patterns to yours. These reviews can determine patterns of upcoding, unbundling and other improper billing practices. Occasionally a provider may have a patient base that requires more complex or a higher level of care, but in general each specialty has been statistically examined.
Should the federal or state governments consider a billing pattern to be excessive, as well as investigation, their remedies include immediate payment suspension as well as records requests or even seizure.
Stark/Anti-kickback and False-Claims
Stark and Anti-kickback and False-Claims investigations can be pursued by the government as a civil or criminal matter. Kennedy, Attorneys & Counselors helps any of our clients involved in these matters to navigate the process and reduce sanctions if possible.
Egregious cases of Medicare and Medicaid fraud, such as submitting claims for services never received by the patient, are pretty cut and dry. But health care providers should be careful that they are not inadvertently committing other fraudulent acts.Having legal counsel present when talking to investigators is not an admission of guilt. It’s just good business.
Federal and state agencies are very serious about combating healthcare fraud and investigations and prosecutions have become much more aggressive in recent years. Even an investigation can ruin you professionally and financially. In such a situation, only a skilled and experienced healthcare enforcement action defense lawyer can help you clear your name.