Health Care or Medicare or Medicaid Insurance Fraud Defense
Pennsylvania, New Jersey and Delaware
The primary federal health care fraud statute is found in Section 1347, under Title 18 of the United States Code. However, when the Health Insurance Portability and Accountability Act of 1996 (HIPAA) created a new federal offense, and provided additional funding for the FBI to target health care fraud crimes — medical insurance fraud prosecutions dramatically increased.
Health Care Fraud and Medical Insurance Fraud Crime
If you aware of an official investigation or have already been indicted for a health care fraud crime — your case is most likely a high priority item for the agency or prosecutor involved with it.
- Physicians
- Pharmacies
- Clinics
- Hospitals
- Medical insurance carriers charged with insurance fraud
- Medicare or Medicaid Insurance Fraud
- Ambulance Transportation Companies
- Medical Device Companies
Attorney Mark S. Greenberg, will give your case the high priority it deserves. Mr. Greenberg concentrates his practice on federal criminal defense and limits the number of cases he handles in order to provide each client and every case the proper attention. To arrange for an initial, professional consultation — contact us or call us directly at 267-253-7933.
Deciphering the Paper Trail
As with most federal fraud cases, allegations involving health care or Medicare or Medicaid Insurance Fraud are very paper-intensive. In other words, the government’s evidence is primarily composed of paper documents. Some of the more common allegations in these cases include:
- Medicare or Medicaid Insurance Fraud
- Overbilling or double billing
- Billing for services not rendered
- Upcoding (providing one service but billing for another, more expensive one)
- Providing unnecessary medical services
- Misrepresenting the nature of the services, the dates provided or the identities of either the provider or receiver of those services
What federal agencies and prosecutors often fail to take into account is that billing protocols for programs such as Medicare and Medicaid are extremely complicated, that health care is a very stressful and often understaffed industry and that not every mistake is part of some larger scheme to defraud. We do understand and will pour over the details of the government’s case to find the gaps and inconsistencies in their theory of the case.
There Is Always a Defense – Find Yours Here
To learn more about medical insurance fraud charges, your rights and how we can help call federal criminal defense lawyer Mark S. Greenberg directly at 267-253-7933. Our offices are located in Center City, Philadelphia, but we are available to meet with you at more convenient locations as well.
Mark S. Greenberg: Philadelphia Health Care Attorney
If you have been charged with health care fraud, have been contacted for an audit of your records or believe you are under investigation, contact Mark S. Greenberg a Pennsylvania health care fraud lawyer.
Attorney Mark S. Greenberg, will give your case the high priority it deserves.
Mr. Greenberg concentrates his practice on federal criminal defense and limits the number of cases he handles in order to provide each client and every case the proper attention. To arrange for an initial, professional consultation call us directly at 267-253-7933.
Anyone involved in an erroneous or falsified Medicare or Medicaid claim may be the target of a government investigation into fraud or find themselves charged with Medicare/Medicaid fraud:
- A doctor who conducts an allegedly unnecessary surgery
- An accountant or office administrator who "conspires" by turning in charges for medical treatment that was not provided
- A patient who signs a form stating he or she received a treatment or a medical device that was not received
- An ambulance company which bills Medicare for medically unnecessary transport
Combating Medicare and Medicaid fraud is a favorite topic of politicians looking for ways to balance the budget. Increased attention has been given recently to the billing practices of doctors, clinics, therapists, and durable medical goods providers. Government officials are conducting Medicare / Medicaid billing audits to identify areas of waste, abuse and fraud.
Even if you were not actively involved in any wrongdoing, but knew of irregularities in billing and took no steps to stop it, you may face federal criminal charges for conspiracy to commit fraud against the government. A doctor may be charged as a co-conspirator for failure to assume responsibility for Medicare or Medicaid fraud happening under his or her watch.
The primary federal health care fraud statute is found in Section 1347, under Title 18 of the United States Code. However, when the Health Insurance Portability and Accountability Act of 1996 (HIPAA) created a new federal offense, and provided additional funding for the FBI to target health care fraud crimes — medical insurance fraud prosecutions dramatically increased.
Internal Investigations and Medicare Audits
Corporate officers need to understand exactly what actions have occurred and whether those actions are, in fact, violations of any law. When that is known, your business can develop a remediation plan to prevent such actions in the future. This can often head off criminal charges.
Mark S. Greenberg a Philadelphia health care fraud lawyer can take a proactive approach by assisting your company in conducting its own internal investigation in advance of an audit, in tandem with an audit or following an audit. We take a team approach to internal corporate investigations, working alongside company personnel and with experienced investigators to determine what has occurred.
Some doctors and clinics are under investigation or are facing criminal charges for fraudulent billing practices although they use an outside service to handle all their medical coding and billing. It may be this company or one of its employees who has made an innocent error or fraudulently billed Medicare, Medicaid or another insurance provider for medical charges.
Medicare fraud charges can be brought in state or federal court. The rules of evidence and guidelines for sentencing can be quite different between the two so it's wise to choose a defense attorney who has handled cases in both courts.
Defense attorney Mark S. Greenberg has more than 30 years of defense experience in Pennsylvania and U.S. criminal courts. He has won hundreds of criminal jury trials and he personally handles each and every case he takes to court.
Deciphering the Paper Trail
As with most federal fraud cases, allegations involving health care or medical insurance fraud are very paper-intensive. In other words, the government’s evidence is primarily composed of paper documents. Some of the more common allegations in these cases include:
Overbilling or double billing
Billing for services not rendered
Upcoding (providing one service but billing for another, more expensive one)
Providing unnecessary medical services
Misrepresenting the nature of the services, the dates provided or the identities of either the provider or receiver of those services
What federal agencies and prosecutors often fail to take into account is that billing protocols for programs such as Medicare and Medicaid are extremely complicated, that health care is a very stressful and often understaffed industry and that not every mistake is part of some larger scheme to defraud. We do understand and will pour over the details of the government’s case to find the gaps and inconsistencies in their theory of the case.
We defend clients on a wide range of healthcare fraud charges, including:
- Fraudulent billing for services not rendered
- Fraudulent billing for durable medical goods the patient did not receive
- Fraudulent cost reports
- Referrals for services not needed in exchange for a share of profit
- Fraudulent Medicare billing for clients who do not actually exist
The Medicare Billing Audit
If you have been notified to expect a Medicare billing audit, the auditor will ask to see records and receipts relating to medical product purchases and pharmaceutical purchases. They may ask about referral relationships, looking for evidence of conspiracy or kickbacks. They may ask to talk directly to patients who are said to have received services paid by Medicare or Medicaid.
There Is Always a Defense – Find Yours Here
To learn more about health care fraud charges, your rights and how we can help — contact us online or call federal criminal defense lawyer Mark S. Greenberg directly at either or 267-253-7933. Our offices are located in Center City, Philadelphia, but we are available to meet with you at more convenient locations as well.
Contact Pennsylvania Health Care Fraud Lawyer Mark S. Greenberg
If you or your medical-related business has been notified of a billing audit, if you suspect that you are under investigation, or if you have been charged with health care billing fraud, contact the law office of Mark S. Greenberg to schedule a free consultation.
Mark S. Greenberg a Medical Insurance Fraud Defense lawyer with more than 30 years of experience in investigations. He has personally directed hundreds of investigations.
It is not too early to understand and protect your rights. Whether you need legal counsel during an investigation or after charges have been filed, Mark S. Greenberg is prepared to deliver. Contact a Pennsylvania Medicaid fraud lawyer at 1-267-253-7933
