Lab Services Fraud Explained by a New York City Criminal Lawyer
Laboratories provide a wide variety of services to help monitor health status and to obtain information on patient health. Labs bill insurance companies and patients for the services they can provide, but billing for the testing and diagnostic treatments offered in laboratories can sometimes lead to allegations of lab services fraud.
If you or your laboratory has been accused of improper billing or other fraudulent activities, you need a NY criminal lawyer with experience in Healthcare Fraud cases. Bukh Law Firm, PLLC provides legal representation to labs, hospitals, clinics, care providers, billing coordinators, patients, and others who are accused of involvement with lab services fraud. Give us a call as soon as possible to get an experienced legal defense team on your side and fighting for your future.
What is Lab Services Fraud?
Lab services fraud involves making intentionally misleading statements or intentionally making material omissions in regards to lab services performed or in regards to claims for payment made to insurance providers or patients. Examples include:
- Double billing Billing multiple times for performing the same service. The Justice Department reported on a lab that faced legal consequences for double billing when charging for fetal biophysical profiles with non-stress tests and then separately billing for standalone non-stress tests.
of services. Some insurance codes combine multiple parts of a test under one code. Labs sometimes charge separately for each component of the test or service instead of using the code they should be using. Unbundling or billing separately for different parts of the test means they can charge more for the Unbundling services. unbundled
- Billing for medical unnecessary lab tests: Patients or insurers are billed for
was not medically necessary. testing which
- Billing for laboratory tests that were not actually performed. The lab charges for processes and procedures it did not do.
- Billing for lab tests that weren’t ordered. Labs should only conduct testing as ordered or recommended by doctors.
It is also illegal for kickbacks to be paid, solicited, offered, or accepted in order to induce a patient to seek services covered by insurance. If a lab pays a doctor or provides other financial incentives to send lab work to that particular facility, this is an example of illegal kickback fraud, which can result in imprisonment and financial consequences.
Penalties for Lab Services Fraud
Lab services fraud is a form of
These criminal acts can result in anywhere from five to 10 years imprisonment in a federal prison. Defendants can face multiple criminal charges if they were involved in a series of fraudulent transactions. State laws also prohibit insurance and
Jail time is just part of the possible penalties which could result from a conviction for lab services fraud. Criminal and civil fines and penalties can also result in crippling financial loss, which can make it impossible to continue running a business or which can leave individuals bankrupt. Defendants can lose far more than they obtained in the fraud as a result of civil and criminal claims against them.