Health care fraud investigations and prosecutions are on the rise
Scrutiny of physicians and other medical professionals can lead to career-ending charges.
A mere investigation can cause untold damage to one’s reputation, to say nothing of the possible criminal penalties.
Defending against health care fraud and protecting your reputation requires immediate action.
Dan Guthrie is an accomplished white collar criminal defense attorney and has successfully defended numerous clients at the investigative, indictment and trial stages of health care fraud cases.
In most investigations, the biggest hurdle for the government is proving intent beyond a reasonable doubt
Medicare and health care fraud allegations can involve many different types of conduct, including:
- Upcoding, or using incorrect current procedural technology (CPT) codes to bill for more expensive procedures than those actually rendered
- Unbundling, or charging medical procedures separately when they should be charged together
- Billing for services not rendered
- Performing unnecessary medical procedures to receive insurance payments
- Misrepresenting elective surgeries as medically necessary procedures
- Receiving or paying kickbacks
The fact is that billing procedures for Medicare and Medicaid are extremely confusing, even for people who work in these agencies. As a result, proving intent in these prosecutions can be difficult.