Medicaid/Medicare Fraud Attorney in Denver, Colorado

As previously stated, both beneficiaries and providers can face charges of insurance fraud. Whether you are a medical care provider such as a physician, nurse, or medical billing employee; or you are a patient charged with fraud, you need to hire a Denver healthcare fraud lawyer immediately.

Some of the common reasons a provider can face charges are:

• Overbilling of Services – providers who have not performed services and have billed for them could face charges of fraud. These charges are very serious as they could ultimately result in the provider being banned from receiving any type of payment from these programs. False diagnosis is also another common way providers have defrauded Medicaid and Medicare.
• Violation of Stark and Anti-Kickback Laws – providers are strictly prohibited from referring patients to other providers in return for any type of financial gain. This includes referrals for any type of services including laboratory work, physical therapy, second opinions, etc. All types of providers and medical billing companies are bound by these rules.
• Up Billing Patients – when a hospital, physician’s office or a billing company improperly codes procedures or they bill services individually when they are offered as a “bundle”. All submissions for reimbursement must be properly coded and if a pattern of abuse is discovered the provider could face fraud charges.

Beneficiaries of Medicare or Medicaid are not exempt from charges of fraud. Some of the ways beneficiaries can defraud the system include:

• Falsifying Application Information – understating income, overstating household size and hiding assets have all been ways that beneficiaries have qualified for assistance under these programs. Should they be discovered, they may be barred from receiving these benefits as well as other federal or state benefits.
• Improper Use of Medical Insurance – beneficiaries have been found guilty of allowing a non-eligible person to use their insurance card for the purposes of obtaining services. Doing so violates the law and also will result in the eligible beneficiary losing their coverage.
• Tampering With Receipts and Bills – beneficiaries who tamper with properly issued bills or receipts in order to increase the amount they may be entitled to be reimbursed are violating both state and federal laws and will face harsh penalties including the loss of coverage.