NY Hospital Fraud Lawyer Explains Hospital Billing Fraud
Hospitals perform thousands of life-saving services each year. Billing for all of these services can be very complicated, and mistakes can sometimes be made. Unfortunately, this can lead to allegations of hospital billing fraud. A hospital accused of overbilling or improperly billing could face civil and criminal penalties, as well as damage to the institution’s reputation.
Any facility which has been accused of hospital billing fraud needs to ensure that it has appropriate legal representation to fight against all accusations that are made. Your hospital fraud lawyer needs to understand how to represent your interests in state and federal criminal cases, as well as in civil claims. Most allegations of fraud are resolved through the negotiation of a financial settlement, so having an experienced criminal defense lawyer allows you to protect dollars best used for patient care. If you need to go to court, having representation provided by an experienced litigator will be essential.
Bukh Law Firm, PLLC provides legal representation to hospitals, billing services, and those in charge of hospital billing. If your institution is facing charges or you are personally at risk of a criminal or civil case against you, give us a call so we can assist you in developing a strong legal response to serious allegations.
Hospital fraud takes many different forms. Some examples of illegal fraudulent behavior can include:
- Unbundling: Tests or services are broken down into a series of steps and a hospital bills for each step or part, rather than using one billing code designed to cover the entire service.
- Upcoding: Hospitals bill for more expensive services than the services that would be justified based on best practices.
- Providing unnecessary medical services: A hospital facility performs medical services that are not necessary or recommended for patients for purposes of billing for the services being provided.
- Billing for services which are not provided. Hospitals charge insurance companies for services which patients never actually received.
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Mistakes can be made in hospital billing, and a simple error does not constitute fraud. In order for a defendant to be convictied of fraud charges, there must have been an attempt to deceive. False statements, materially misleading statements, or material omissions must have been made intentionally for purposes of obtaining money or benefits. If a prosecutor is unable to prove willful and intentional billing fraud, defendants should not be charged for a criminal offense.
Because most hospitals bill Medicare and Medicaid, the Federal government will generally take action due to fraud against these government health programs. Fraud is also illegal under New York State law, so state action could occur due to fraud as well. Federal statutes and state laws impose prison sentences for individuals who make false or misleading statements in connection with healthcare benefits or healthcare claims. Hospital institutions cannot be sent to prison, but can still face significant financial consequences as a result of criminal convictions.
The Federal False Claims Act also provides that civil penalties may be imposed in cases where fraudulent claims for government benefits are made. Whistleblowers are encouraged to file qui tam lawsuits when they become aware of wrongdoing, and there is a major financial incentive for people to come forward and file these lawsuits claiming fraud because the whistleblowers get a part of the money recovered if the case settles or a court determines that the hospital defrauded the government.
With the possibility of serious criminal penalties as well as major financial loss in civil cases, it is imperative for individuals and hospital facilities to take allegations of hospital fraud seriously. If you are accused of any type of billing fraud or other hospital fraud, call Bukh Law Firm, PLLC today. Our experienced legal team will help you to negotiate a settlement or to develop a legal defense strategy for both criminal and civil court cases. Call now to learn more.