Billing Fraud

It's not uncommon for health care professionals and providers of medical equipment to find the Current Procedural Terminology (CPT) codes or the Health care Common Procedure Coding System (HCPCS) to be confusing. The CPT codes for medical services may be difficult to determine and may depend upon factors that are often unclear or subject to differing interpretation.

As a result of this confusion, incorrect billing and classification codes can be used repeatedly by staff in the clinic or doctor's office without any intent to commit fraud or overbill.

If your office is being audited or is under investigation for health care billing fraud or if you have been arrested, contact the Law Offices of Mark L. Horwitz today to learn how we can help.

Our defense attorneys understand CPT codes and the issues involved in determining how medical services are classified and billed. We work with health care billing experts, medical specialists and accountants to build a defense for our client's billing practices to refute charges of unbundling or upcoding.

Accusations of Health Care Billing Fraud

Our firm defends medical providers and their staff in Medicare fraud, Medicaid fraud and private insurance fraud cases involving coding errors and overbilling problems such as:

  • Upcoding (using the wrong code so as to bill for a more expensive procedure), and
  • Unbundling (breaking a visit or a medical procedure down into several codes)

Early Intervention in the Investigation Stage

While we cannot guarantee any particular outcome, your chances of avoiding criminal charges are better when you involve a lawyer early in your case, as soon as you know there is a Medicare or Medicaid audit or investigation underway.

A repeated billing error can create the appearance of a pattern of fraudulent behavior. By explaining to investigators how the CPT coding errors were made and discussing ways to rectify the problem, we vigorously defend the medical professional facing criminal charges.

Contact a Health care Billing Fraud Defense Attorney

Responding to allegations of upcoding, unbundling or over-billing of Medicare, Medicaid and private insurance requires a creative and vigorous defense. Our attorneys work to help clients avoid criminal charges, legal complications and heavy penalties. To schedule a confidential consultation to discuss your case, contact the Law Offices of Mark L. Horwitz.