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We are an elite criminal defense law firm, that emphasizes providing the best service and professionalism to all clients. We service a curated clientele nationwide – that expect the best from their lawyer. We handle tough criminal defense and legal situations that require deep knowledge, experience, dedication, and excellence in order to win. We have over 50 years of combined experience, handling national and international cases.

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Excellent results begins with top notch service. We treat you like family, and you always know what's going on with your criminal defense case.

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When you hire our law firm, you work directly with a senior criminal defense attorney only. This ensures the best results possible.

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We 100's of 5 star reviews, and have been featured in the media. We are a premier law firm who understands how to win cases.

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The Spodek Law Group is one of the most successful law firms in the USA. Our success comes from the fact we are attentive to details, and take a very pragmatic approach to each and every single case. Our clients turn to us for realistic advice – so they can make the appropriate decisions they need to make personally. Our goal is to make sure your case ends in a positive outcome, not only personally – but for your family as well.

 



What Is Healthcare Billing Compliance?

Billing and coding are two of the primary ways healthcare providers such as doctors or hospitals can get in trouble. With the complexity of healthcare billing codes, mistakes are inevitable, which can cause problems such as under-billing, increased administrative costs to correct errors, and damaged professional relationships.

A more serious problem occurs, however, when these errors trigger investigations of fraud. Whether the accusations come from private insurance carriers or from governmental programs like the Centers for Medicare & Medicaid (CMS), these simple mistakes could lead to severe penalties under the False Claims Act. Increasingly, these investigations can lead to criminal investigations and arrests for federal healthcare fraud.

The good news is that many of these mistakes are preventable. If a mistake still inevitably happens, it isn’t part of a larger pattern of abuse, so insurers are more likely to let you correct an error instead of filing charges.

Medical billing is too complex, and too important, to take any chances. Each year, there is an estimated $400 billion of healthcare fraud. For this reason, there are a number of agencies aggressively pursuing and prosecuting these cases, including federal prosecutors, the Office of the Inspector General (OIG), the Department of Health and Human Services (HHS), the Medicare Fraud Strike Force, the Federal Bureau of Investigation (FBI), the Medicaid Fraud Control Unit, just to name a few.

These groups have specially trained federal investigators, outside investigative companies, and computer programs written to look for any “outliers.” These outliers show providers who have levels of billing outside the norm for their region and specialty, a high number of incorrect coding errors, or other red flags for fraud. For example, when comparing all doctors who perform hip replacement surgeries in Miami in a given year, are there are few doctors who consistently bill additional treatment outside the norm? Is there a pattern that could indicate bills are being padded, patients are receiving unnecessary treatment, or billing for work not even completed?

A few examples of fraudulent billing charges include:

* Billing for Services Not Provided – Billing for a procedure that wasn’t provided, or charging for a more expensive piece of equipment than was actually used.
* Billing for Medically Unnecessary Services – Performing services on patients that don’t meet the treatment criteria.
* Billing for Mutually Exclusive Services – Billing for two different procedures that can’t be performed simultaneously, or services that are medically impossible such as gender-exclusive procedures.
* Billing Unreasonably High Levels of Care (Upcoding) – Charging for more serious and expensive treatments than necessary.
* Billing for Services Not Covered – Billing insurer for services that are excluded under the policy.
* Failing to Collect Copays – Routinely waiving copays is considered fraud because it creates a false image of the actual service charges. For example, if your patient has a $20 copay, the insurance company pays $80 on a $100 charge. If you waive the copay, then the bill was actually only $80, not $100, and the insurance company should only pay $60.
* Billing for Out-of-Network Services – Submitting bills that aren’t qualified because the treatment is considered out-of-network.

For the healthcare provider, this high level of scrutiny means that you can’t make mistakes. You have to ensure that your business is organized and keeps accurate records to prevent violating the False Claims Act. Or at least that any small mistakes don’t end up looking like criminal fraudulent activity.

Call us today to learn how we can implement your billing and compliance protocols to protect you from mistakes that could lead to criminal investigations and prosecutions. Keep in mind that criminal and civil investigations of healthcare fraud carry significant penalties, including lengthy prison terms, loss of your medical license, CMS exclusion, and large monetary penalties, all meaning the end of your career at the very least. You need an experienced attorney to help you navigate the complicated world of medical billing so you can rest easy.


Charle Butler
Charle Butler
2021-03-12
I was hesitant to hire the Spodek Law Group. I read reviews and knew they have a great reputation. However, I thought I would spend money and not see or speak to my attorney. From the beginning to end of my case Todd and the entire staff were available and willing to help. We worked towards and end result that was way above my expectation and Todd delivered. I am forever grateful for patience and long days and night spent working on my case. Thanks Todd and the entire team!
Mesonista parsons
Mesonista parsons
2021-03-05
My attorney at Spodek was Abigail. She was very knowledgeable and helpful with all my questions and concerns, as well as responsive. Her fees are affordable and Abigail took the time to make sure I understood everything relating to my case. I highly recommend Abigail and will request her services in the future.
debabrata chakraborty
debabrata chakraborty
2021-03-03
Todd A Spodek is the experienced and best criminal lawyer at USA. He is very professional and always respond on time. Alex also very cooperative and always help me. They took care me and my problem like family member. I am 100% satisfied for their professional service. My result was unexpected and amazing. They dismissed my case. I am really grateful to them. I will recommend you to go there if you want to solve your problem. I wish all the best for them.
Asata Hendricks
Asata Hendricks
2021-03-02
Truly appreciate the work the guys did!. Exceptional team & I know they care about each and everyone of their clients. I am super thankful to be referred to Spodek Law Group and I am grateful Todd & Alex were able to work diligently to achieve an outcome I am pleased with. Despite COVID they stayed on top of things and kept me informed every step of the way. Very thankful.
Mike Moroff
Mike Moroff
2021-02-26
I'm very satisfied with the services rendered by Todd, Alex and Mary Lou. I whole heartedly recommend Spodek Law Group . I've worked with and have retained other attorneys in the past with Todd's firm being the cream of the crop for many reasons. A very serious legal matter was resolved after a year's hard work and effort. Todd expertly guided me through the process and was able to navigate and make the good journey bearable as well as successful. Mary Lou initially provided excellent assistance before referring my case to Todd. Alex's support was effective and timely. The customer portal (MyCase) is an invaluable communication tool that also kept track of my case. Various aspects of my case were explained and there were several options provided but I made the final decision of how the case would be handled. The legal fee was reasonable considering the effort and amount of work plus it was a flat fee regardless of the length of time required to conclude my case. Todd made himself available to me and we had many scheduled meetings to go over the progress and to discuss the next steps. I felt more confident after many discussions with him. You will not go wrong choosing Spodek Law Group for legal matters.
Josh Katz
Josh Katz
2021-02-24
Being that it was the first time that I was in need of an attorney, I was afraid and hesitant and knew I needed the absolute best. It is beyond understood why Spodek Law Group has a reputation of being the top, if not the best law firm in New York. Alex and Abigail were there every step of the way even at the most unconvenient hours. I could not have asked for more. They are extremely good at what they do and they delivered much much more than just winning my case. A big thank you to Alex and Abigail for all the guidance and counseling and their upmost loyal support that extended far more than just legally. If you need the absolute best than don't hesitate to hire Spodek Law Firm.
L.C.
L.C.
2021-02-24
I cannot tell you how thankful I am to Todd and Alex for their hard work and dedication to my case. I had never been in any trouble before but I had an unfortunate event occur and in the midst of COVID-19 at that therefore I knew I needed a team that was dedicated to my success. Today- my case has been finalized and I’m walking away with no record and can continue life as a mother and a Grad student worry free. I cannot express enough gratitude for their assistance.
AnnMarie Soliman
AnnMarie Soliman
2021-02-23
I received a summons and called Spodek law group for a free consultation. Alex took my call and was very quick and responsive. He was available anytime through multiple platforms and very reassuring when needed. They are extremely organized and thorough. They got my case dismissed! I’m very grateful. Thank you Alex and Todd!

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Testimonials

Spodek Law Group have offered me excellent support and advice thru a very difficult time. I feel I've dealt with someone who truly cares and wants the best outcome for you and yours. I'm extremely grateful for all the help Spodek Law Group has offered me. I can't recommend them enough.

~ David Bruce

Spodek Law Group was incredibly professional and has given me the best advice I could wish for. They had been helpful and empathetic to my stressful situation. Would highly recommend Spodek Law Group to anyone I meet.

~ Rowlin Garcia

Best service I ever had. Todd is absolutely class personified. You are in the safest hands with spodek. They have their clients interest in mind.

~ Francis Anim

Spodek Law Group

White Glove Service

We provide superior service, excellent results, at a level superior to other criminal defense law firms. Regardless of where your case is, nationwide, we can help you.



Hear From Our Clients

"Spodek Law Group have offered me excellent support and advice thru a very difficult time. I feel I've dealt with someone who truly cares and wants the best outcome for you and yours. I'm extremely grateful for all the help Spodek Law Group has offered me. I can't recommend them..."

David Bruce

"Spodek Law Group was incredibly professional and has given me the best advice I could wish for. They had been helpful and empathetic to my stressful situation. Would highly recommend Spodek Law Group to anyone I meet."

Rowlin Garcia

"Best service I ever had. Todd is absolutely class personified. You are in the safest hands with spodek. They have their clients interest in mind."

Francis Anim
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