Today, almost all healthcare providers are seeking the help of the healthcare lawyer to resolve alleged false claims and allegations charged against healthcare facilities. Even more important is to have a knowledgeable Healthcare Attorney to help avoid such allegations of false claims, to begin with in the first place by use of a good Compliance Program. Any sort of adverse allegations, be it fraudulent billing practices, fraudulent cost reports, Medicare fraud or Medicaid fraud can adversely effect the status of the healthcare provider, supplier or facility. A Healthcare fraud attorney who has significant experience in investigating fraud, conducting fraud audits and civil and criminal Medicare fraud actions is indispensable for a conscientious healthcare providers operations. The major clients of healthcare lawyers, attorneys include physicians, chiropractors, pharmacists, home health agencies, urgent care centers, and behavioral health facilities, hospitals, ambulatory surgery centers, suppliers and other such healthcare providers. These are the providers who get accused of Medicare fraud. The healthcare fraud attorney is vital to those who have been charged with any of the offences and vital to avoiding being charged. An effective Compliance Program is an essential tool that the effective Healthcare Attorney uses to protect his clients.
The healthcare fraud attorney has an optimum understanding of the Medicare and Medicaid issues, risk assessments, grant review, academic medical centers, billing, coding, HIPAA, and the various types of civil, criminal, and administrative cases. They assess the merits of the case and handle it carefully. They are responsible for resolving allegations related to fraudulent activity or allegations of compliance failure made against you from the state or federal government agencies or third parties or former employees. They help you get out of the problems because they often know how to extricate you from difficult situations. The healthcare professional also negotiates on the fine and penalty imposed on the medical institutes or the doctors for possible overbilling or due to lack of care given to customers.
Some effective pointers to describe Medicare fraud:
- Submitting false claims to CMS for payment and duplicate billings and up-coding
- Billing for services and supplies not provided
- Submitting claims for patients who does not exist or who is not ever treated by the physician
- High billing for low-quality service that is virtually worthless
- Billing for durable medical equipment not legitimately prescribed by doctors
- Billing for tests or treatment unbundled
- Lack of medical necessity and overutilization
In addition, the healthcare attorney is responsible for resolving allegations made against medical facilities and help them to resolve these issues. Make sure that the healthcare lawyer, attorney who you choose has enough experience to resolve the cases no matter how complex they are.