Have you been accused of Medicare fraud? Did you know that this is one of the most profitable crimes in America? Taxpayers pay an estimated $60 billion each year due to this type of fraud. Because the laws and regulations regarding Medicare are constantly changing, these cases are very complex. However, the government is cracking down on fraudulent cases in an effort to reduce the overall costs of the program. These cases are expensive to prosecute because they can cost hundreds of thousands of dollars in investigative expenses alone. The first step towards building a successful healthcare fraud defense is to understand the complex rules and regulations that govern the Medicare system.
Do I Have a Good Medicare Fraud Case?
The first thing that Spodek Law Group does is examine the evidence being used against you. We ask for discovery to review the charges. We must see if they have a good Medicare fraud case against you. The Medicare program was created to provide insurance to people who are age 65 and older, are younger than 65 but have a disability, and people who have been diagnosed with either Lou Gehrig’s disease or end-stage renal failure. To commit fraud, there must be a deliberate act of deception on your part. These cases involve many layers of intricate and detailed information, which is why we must work hard to thoroughly review the claims and see if they can be substantiated.
What is Medicare Fraud?
Medicare fraud is a broad term that covers many different aspects. First, a company can bill Medicare for services that they never received or provided to customers. While the exact types are diverse, the goal is the same, unlawful billing of Medicare. Here are some of the most common cases of Medicare fraud that Spodek Law Group handles:
*Double Billing: This fraud occurs when Medicare is charged twice for the same services.
*Phantom Billing: When a health care facility bills for tests or services that they did not perform or uses the names of employees that do not exist, then it is considered to be phantom billing.
*Pharmaceutical Fraud:Pharmaceutical Fraud: There is much fraud on the pharmaceutical end of the program. Things often seen include receiving kickbacks, fixing prices, using off-label marketing, and other schemes that help to increase the profits and payments from Medicare.
*Upcoding and Unbundling:Current Procedural Terminology is the billing codes used to bill Medicare. Bundling claims together are using two or more of the CPT codes together. This inflates bills and is fraudulent.
*Lack of Medical Necessity:Was the medical services provided medically necessary? In many cases, tests and services are not necessary and are given in an attempt to collect additional revenues from this government program.
The Three Stages of a Medicare Fraud Case
Medicare fraud cases are divided into three stages, an evaluation, review of claims and billing practices, and our findings. First, we will perform and in-depth background evaluation of the fraud allegations. Do they have sufficient grounds to charge you or your company with any type of fraud? We start by gathering documentation, any witnesses you have on the matter, and look for critical evidence that can help your case.
Second, we look at all of your billing practice patterns. Our goal is to pinpoint all the fraudulent claims and to understand the details surrounding each one. We look at these claims and compare them with the Medicare benefit regulations and CMS instructions. Did your company have legal violations that are blatant and easy to see? This part of our investigation is time-consuming, but our findings can help get these charges dismissed. We need the support from you and your staff to ensure this part of the phase goes smoothly.
Lastly, we document all of our findings and come to a conclusion. It is from this conclusion that we know how to proceed to defend you in a court of law. The government will conduct their own independent investigation on your case. However, we confidentially disclose our findings to the Department of Justice on your behalf.
Choosing the Right Medicare Fraud Lawyer
The difference between winning or losing your case can be as simple as the Medicare fraud lawyer you select. If you have been charged with defrauding the government, you have a serious fight on your hands. You should never attempt to handle such a claim on your own. Our experienced law firm can help you protect your rights each step of the way.
Spodek Law Group will aggressively fight on your behalf. We understand that these are trying times and you want to clear your name. It is our desire to see these charges cleared and you can continue to run your business without issue. With more than 50 years of combined experience, it is easy to see we are more than qualified for the job.
Todd is a miracle worker who will work tirelessly for you and your family. He is one of the few attorneys i've met - who I earnestly trust to protect me, and who I am happy to refer to our friends and fellow family members. The Spodek Law Group is someone you want on your side, because they will treat you just like family. Todd and his team are available 24/7, and they always answered our calls. Even when we were being irrational, and crazy - they were calm and super helpful. Just call Todd. He gives you a free consultation and is very understanding.- Donna & Robert
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