Medical billing is rife for the chance to commit error. It is full of codes that must be submitted for claims to recoup costs of various services rendered in the medical world. The number of diagnostic codes has skyrocketed from 17,000 to over 60,000 in the past few years, creating a huge burden for medical billers. All it takes is one typo – one missed letter or number – for the code to refer to a completely different service, resulting in a completely different cost. If error is committed, and it was completely unintentional, then medical facilities may only face civil liability. But if it was done with the intent to defraud the federal government and receive money that was unearned, it is a crime – one that has been heavily investigated and prosecuted by the FBI and Department of Justice, respectively.

Representing Medical Billers:

Audits are implemented, usually by government agencies, to determine whether the billing error was committed by mistake, or if it was done with loftier goals in mind. If you receive an audit, it is important to get in touch with a healthcare defense attorney immediately. The medical industry faces many regulation, both state and Federal, and it can be a veritable minefield for someone without any legal knowledge. An attorney will be able to advise you of your rights and duties under the law, as well as help prepare your response to the audit.

Healthcare fraud does not sound like a major crime; however, if convicted, the defendant faces a multitude of penalties. First, there is a good chance that, if they are a doctor or medical professional, they will lose their license. This includes medical billers, who are very often certified. Next, many convictions come with jail time, civil penalties and restitution, or a combination of all three. A good attorney can help you get the best possible outcome if you are the target of an investigation. Sometimes, this means that they get the government to focus only on a civil violation of the law, rather than a criminal violation. This will happen if the errors that occurred were inadvertent. Other times, an attorney might be able to negotiate a more palatable punishment through a good plea deal. Either way, the attorney will be able to guide you, and offer up plenty of defenses and ways to combat accusations of wrongdoing.

If one of the crimes is ‘upcharging,’ or charging for services that were unnecessary, hiring a medical expert might be required to properly defend you. An attorney will know who to hire, and more importantly, will know how to elicit appropriate information, as well as cross-examine any other expert witness the prosecution may hire. This can be the difference between a conviction and an exoneration. That is because upcharging very often turns on the facts of the case or the rules of healthcare reimbursement, as well as the doctor’s own personal opinion. There are, therefore, large areas of reasonable disagreement. An attorney can help flesh these out in defense of medical billing errors.

Finally, once an investigation begins, the prosecution will request a plethora of documents, from patient records to personal and private bank accounts. Hiring a competent attorney to advocate for you can help limit any abuse from the prosecution of trying to obtain these documents. Attorneys can object to subpoenas and requests for depositions, as well as use their own power from the court to demand the prosecution to release any evidence they may have accumulated in the case.

Medical billing offers a lot of opportunities to make mistakes – hiring an attorney even before one is made is your best bet. Attorneys can help you run internal audits before the government gets involved, helping you determine what practices and procedures leave you open to risk. In these cases, the best defense is a good offense.