Kendall Medicare Fraud Lawyers – Protecting Your Rights

Medicare fraud is a serious issue that can carry steep penalties if convicted. However, the complex laws and regulations governing Medicare billing and coding often create confusion over what constitutes fraud versus simple errors. This is why working with an experienced Kendall Medicare fraud defense attorney is essential if you find yourself under investigation.

This article provides an overview of common Medicare fraud charges, potential defenses, and what to look for when hiring a lawyer to represent you. With the right legal guidance, many individuals and healthcare providers accused of fraud are able to get charges reduced or dismissed entirely.

Understanding Medicare Fraud Allegations

Some of the most common allegations of Medicare fraud include:

• Billing for services never performed: This involves billing Medicare for appointments, tests, procedures or other services that never actually occurred. Even if it was an innocent mistake, failing to reconcile errors can lead to fraud charges.
• Upcoding services: Upcoding is when a healthcare provider bills for more complex or expensive services than were actually delivered. For example, billing for an hour-long patient appointment when only 30 minutes was spent.
• Billing for medically unnecessary tests/procedures: Ordering excessive or unnecessary tests and procedures solely to generate higher Medicare reimbursements constitutes fraud.
• Violating the Anti-Kickback Statute: This federal law prohibits paying or receiving bribes, kickbacks or other financial incentives to influence referrals for federally-funded healthcare services like those covered by Medicare.
• Using misappropriated beneficiary numbers: Using a Medicare beneficiary’s number without their consent to bill services for another patient is considered fraud.

The key thing to understand about Medicare fraud is that intent matters. Simply making occasional billing errors or having a legitimate misunderstanding of coding rules does not necessarily mean you engaged in intentional deceit.

An experienced lawyer can argue a lack of criminal intent as part of your defense.

Common Defenses Against Medicare Fraud Charges

Skilled Medicare fraud defense attorneys have in-depth knowledge of the healthcare industry’s complex regulations and standards. They use this expertise to build strong legal arguments by identifying:

• Improper procedures: Arguments may focus on flaws in the investigation procedures, such as illegal searches or seizures that violate 4th Amendment rights.
• Missing elements of fraud: As mentioned regarding intent, failing to prove deceit for illicit financial gain can defeat fraud charges.
• Mitigating factors: Demonstrating the billing issues were accidental, stemming from poor internal controls versus willful misconduct, can reduce penalties.
• Statute of limitations expirations: Not all fraud investigations fall within the applicable statute of limitations timeframe dictated by federal regulations.
• Lack of standards/guidance: Another avenue is demonstrating that regulators have failed to provide clear billing and coding standards, creating confusion versus intentional deceit.

Skilled lawyers understand both the letter of the law and the standards of enforcement. They can identify technicalities and other issues with the prosecution’s argument to get charges dismissed or reduced.

Choosing the Right Medicare Fraud Attorney

If you are under investigation for Medicare fraud, your choice of legal counsel could impact whether you face criminal conviction versus getting penalties waived. Important things to look for include:

• Specialization in healthcare fraud defense: Ask about case experience. Have they defended Medicare fraud cases successfully before? Find out their track record.
• Knowledge of regulations: Discuss defense strategies. Do they seem knowledgeable about Medicare billing rules, standards and typical fraud enforcement?
• Communication skills: They should listen to your side of the story and clearly explain your options.
• Fees/costs: Get quotes from multiple attorneys and balance costs against years of legal expertise. However, remember that public defenders are not always well-versed in the nuances of Medicare fraud law.

Do your research to find the most qualified Kendall Medicare fraud lawyer within your budget. The stakes are high, but an experienced attorney can help protect your rights and interests during the investigation and legal process.