Health Care Fraud
Albany Medicare Fraud Lawyer
If you work in any sector of the health care industry, you may be accustomed to all types of pressure — from patients, regulators, insurers and more. Because of the near-universal concern about rising costs and several prominent cases, federal agencies have increased attention and resources devoted to exposing and prosecuting health care fraud.
New York Attorneys for Your White Collar Crime Defense With Offices in Albany and Schenectady
Whether you are the CEO of a health care or insurance company, a doctor or other professional provider, or anyone else under investigation for health care fraud, you need an experienced, resourceful defense lawyer who has tried and won complex, high-stakes cases in state and federal court. To request a consultation with attorney Mark J. Sacco or James E. Tyner, call our firm or contact us online today.
The False Claims Act Prohibits Physicians From Filing Fraudulent Cost Reports in NYC
The False Claims Act generally prohibits a person from defrauding the government. The law specifically prohibits physicians from committing health care fraud by deliberately submitting false Medicaid or Medicare claims. However, since the government reimburses health care providers for costs associated with Medicaid and Medicare, some unscrupulous providers have an incentive to submit fraudulent cost reports by inflating government-covered expenses.
Examples of fraudulent cost reports submitted by physicians, hospitals and nursing homes in Manhattan, Brooklyn, Queens and surrounding areas, include:
- Overbilling– Using improper procedure codes to inflate the bill for services or equipment
- Billing for services that are not medically necessary by misrepresenting a patient’s actual symptoms and/or scheduling unnecessary office visits
- Charging for services unrelated to patient care
- Billing for services or items not rendered
- Double billing the government and the recipient for the same service after shifting the costs of treating non-Medicaid patients to patients covered by Medicaid
- Continuing to bill for home medical equipment after it has been returned
- Substituting generic drugs for high-cost name-brand drugs
It’s Illegal for New York City Physicians to File False Certifications for Medicaid or Medicare
False certifications go hand-in-hand with fraudulent cost reports. Physicians must certify that the services provided were medically necessary, actually performed by a licensed practitioner and performed in accordance with all applicable government regulations, while medical providers and suppliers submitting claims through Medicaid or Medicare must certify that they are fulfilling the obligations of their contracts with the government. Providers who submit false certifications are subject to both criminal and civil penalties under the False Claims Act.
Medicare and Medicaid Fraud — Billing Procedures — Alleged Kickbacks or Other Illegal Payments
We will thoroughly investigate and evaluate your situation. After we have determined an appropriate course, we will fight to protect your rights and interests in all aspects of any government investigation. Our firm will fight for dismissal, acquittal, reduced charges or another favorable outcome. Our firm is prepared to provide defense against allegations and charges associated with:
- Any type of Medicare or Medicaid fraud
- False, duplicate, inflated or other fraudulent claims and billings
- Billing for unnecessary procedures and services
- Deceptive practices involving pharmaceuticals or medical equipment, including Internet crimes
- Providing kickbacks or other illegal incentives
Prepared to Handle Complex Allegations and Litigation
We recognize the complexity of healthcare billing, the challenge of complying with ever-evolving regulations, the strong potential for coding errors and the wide range of views on what constitutes proper health care. Your fraud defense may require extensive research and the ability to develop an innovative strategy, as well as pure legal knowledge.
To discuss vigorous, aggressive representation by an attorney who has experience in complex white collar litigation, contact Sacco Tyner today.