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Healthcare Fraud2019-12-19T21:57:39+00:00

Healthcare Fraud Attorney in Fort Worth 

As healthcare fraud attorneys, we understand that the healthcare system is deeply complex. With so many financial stakeholders at play, today’s providers have to act carefully to avoid committing a federal offense by engaging healthcare fraud — knowing or unknowingly. 

If you have been accused of committing healthcare fraud or violating the Anti-Kickback Statute, you need a skilled healthcare fraud attorney who understands the complexities of your industry and the unique needs of your case. 

The healthcare fraud lawyers at Westfall Sellers have the knowledge and experience needed to build and defend your case. Contact our team today at 817-928-4222 to discuss your options today. 

What is healthcare fraud? 

Title 18 U.S.C. §1347 of the U.S. legal code establishes healthcare fraud as occurring when a medical provider knowingly defrauds a healthcare benefits organization (like Medicare and Medicaid) by submitting false claims or statements regarding services or products that were not delivered or were not medically necessary.

Common examples of healthcare fraud include: 

  • Billing for a non-covered service
  • Filing duplicate claims for one service rendered
  • Altering dates and identities related to rendered services
  • Modifying medical records
  • Prescribing unnecessary treatment, drugs, and/or procedures
  • Falsifying diagnoses for higher payments

These actions are dangerous for patients, providers, and payers alike, but they can also be done unintentionally. Similarly, actions performed in good faith can be construed as fraud by investigators when in reality no fraudulent action has truly taken place. 

If you’ve been accused of any of the above actions, it’s crucial to your welfare and your case that you know how to gather evidence that refutes these claims. A healthcare fraud attorney can help you disprove fraudulent intent and defend your name and your practice against allegations of healthcare fraud. 

What is the Anti-Kickback Statute?

Another aspect of healthcare fraud that providers must be mindful of is the Anti-Kickback Statute. The Anti-Kickback Statute (AKS) is a federal law forbidding healthcare providers from “willingly and knowingly” receiving any kind of payment (monetary or otherwise) in exchange for referring Medicare and Medicaid patients. 

Unlike other examples of healthcare fraud, a provider can be convicted under the Anti-Kickback Statute even if the Department of Justice can’t prove that the provider knew what they were doing was illegal. 

The following actions could be held to added scrutiny due to the AKS: 

  • Specialist referrals
  • Conflicts of interest (equipment rentals, board directorship/membership, etc.)
  • Compounding pharmacies
  • Survey and certification deficiencies 

Because establishing knowledge is not necessary to reach a conviction, it is especially important to work with an experienced healthcare fraud attorney who can help you disprove the allegations outright.

Why providers get accused of fraud

Benefit programs such as Medicare must ensure that their services are being used appropriately. That’s why these programs audit providers and their patient records looking for false statements, unnecessary treatments, or anything else that could result in undue reimbursement from the payer. 

If you receive notice of an upcoming audit, you are both within your rights and advised to seek counsel from a healthcare fraud attorney well-versed in medical laws and benefit programs. Doing so at this stage in the process can help you achieve a successful review and avoid unnecessary investigation by the Department of Justice.

Accused of medical fraud? Facing an investigation? A healthcare fraud lawyer can help.

The second you think you may be suspected of fraud or impropriety, you need the help that only an experienced healthcare fraud attorney can provide. The penalties of medical fraud can be severe; in addition to fines, you may face asset forfeiture, loss of your practice and medical license, and even jail time. 

Don’t risk losing professional relationships and years of hard work to confusion and misunderstandings.  

To discuss how we can help contact a healthcare fraud attorney at Westfall Sellers by calling 817-928-4222 today.