Medicaid And Medical Billing Fraud Defense Attorney In West Virginia
Medicaid fraud and improper medical billing claims can threaten your medical license, career and freedom. For doctors, clinic owners, healthcare leaders and billing managers in Huntington and across West Virginia, a billing issue or audit can quickly grow into a serious criminal investigation.
Attorney Neil R. Bouchillon represents people facing serious and complex criminal cases. His federal defense experience includes his appointment to the Criminal Justice Act Panel by active U.S. District Court judges in the Southern District of West Virginia. Bouchillon Crossan & Colburn, L.C., provides experienced defense when a government investigation puts your career and freedom at risk.
When Billing Allegations Become Criminal Fraud
A billing mistake or overpayment does not automatically mean you committed a crime. However, investigators may take a closer look when they believe the problem goes beyond a single mistake.
A civil or administrative audit may focus on billing errors, records or overpayments. A criminal case is different. Prosecutors must meet the legal standards for the charge, including the required level of knowledge or intent. They may review billing practices, patient records, emails and other evidence when deciding whether to file criminal charges.
Common Medicaid And Medical Billing Fraud Allegations
Healthcare billing rules can be hard to understand. Even so, investigators may look for billing practices that they believe show fraud, including:
- Upcoding and unbundling: Allegations that billing was submitted for a higher-level service than provided or that parts of a procedure were billed separately when they should have been billed together.
- Phantom billing: Charging for services, equipment or appointments that investigators claim you never provided or that your records do not properly support.
- Kickback and referral allegations: Receiving or offering payments, fees or other benefits in exchange for patient referrals or business.
- Prescription and treatment fraud: Providing treatment that was not medically needed, ordering too many tests or improperly billing for drugs and other products or services.
The consequences can be severe. You may have to repay money and face other financial penalties. You could also lose the ability to take part in federal healthcare programs, which may put your practice at risk. A criminal conviction may also lead to prison.
Frequently Asked Questions About Medical Billing Fraud
If you are facing a Medicaid or medical billing investigation, you may have questions about what the process means and what you can do to protect your practice and your rights.
Q: What is the difference between an administrative Medicaid audit and a criminal fraud investigation in West Virginia?
A: An administrative audit usually looks at billing rules, coding and possible overpayments. State agencies or audit firms may ask you to repay money or fix billing problems.
A criminal fraud investigation is more serious. Law enforcement agencies, such as the West Virginia Medicaid Fraud Control Unit or federal agents, look into whether someone knowingly committed fraud. If you are convicted, a criminal case can lead to charges, fines, prison time and other serious penalties.
Q: Can I be charged with Medicaid fraud if my billing staff made an honest error?
A: No. To convict you of criminal Medicaid fraud or false billing, prosecutors must prove beyond a reasonable doubt that you acted knowingly and willfully to defraud the government program. Honest mistakes don’t count as criminal fraud. Neither does coding confusion, nor billing errors made by staff who had no intent to defraud anyone.
That said, prosecutors often try to frame ordinary, repeated billing errors as “reckless disregard.” Because of this, getting a defense attorney involved early is critical. It helps show that you had no criminal intent.
Q: What should I do if federal HHS-OIG agents or state investigators request an interview at my clinic?
A: You have the right to speak with a criminal defense attorney before you agree to an interview with federal agents from the Office of Inspector General within the U.S. Department of Health and Human Services (HHS-OIG), or with state investigators. Before you respond to them, you should also find out exactly what records or information they are asking for.
You can tell the agents or investigators that you want your attorney to handle communication about the matter. Getting legal help early can help you understand your rights and respond in a way that protects your interests.
Federal Defense For Complex Healthcare Fraud Cases
Getting legal help early can be critical if you receive an audit request, grand jury subpoena or target letter. Our defense lawyers at Bouchillon Crossan & Colburn, L.C., can review the allegations, help you respond to investigators and protect your rights throughout the process.
A billing audit or federal subpoena can put your medical practice at risk before a trial even begins. Protect your license and your freedom. Call 304-521-4636 or contact us online to arrange a confidential consultation.