Top Kailua, HI Medicare Fraud Lawyers Near You

Medicare Fraud Lawyers | Honolulu Office | Serving Kailua, HI

1088 Bishop St, Suite 4100, Honolulu, HI 96813

Medicare Fraud Lawyers | Honolulu Office | Serving Kailua, HI

Queen's Court, 800 Bethel Street, Suite 600, Honolulu, HI 96813

Medicare Fraud Lawyers | Honolulu Office | Serving Kailua, HI

705 S. King St., Suite 108, Honolulu, HI 96813

Medicare Fraud Lawyers | Honolulu Office | Serving Kailua, HI

1001 Bishop Street, Suite 1800, Honolulu, HI 96813

Medicare Fraud Lawyers | Honolulu Office | Serving Kailua, HI

915 Fort Street Mall, Suite 601, Honolulu, HI 96813

Medicare Fraud Lawyers | Honolulu Office | Serving Kailua, HI

500 Ala Moana Boulevard, Five Waterfront Plaza, 4th Floor, Honolulu, HI 96813

Medicare Fraud Lawyers | Honolulu Office | Serving Kailua, HI

1001 Bishop St, Suite 1180, Honolulu, HI 96813

Medicare Fraud Lawyers | Honolulu Office | Serving Kailua, HI

Tissue Genesis Tower, 810 Richards Street, Suite 335, Honolulu, HI 96813-2902

Medicare Fraud Lawyers | Honolulu Office | Serving Kailua, HI

Davies Pacific Center, 841 Bishop St., Suite 410, Honolulu, HI 96813

Kailua Medicare Fraud Information

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Lead Counsel Verified Attorneys In Kailua

Lead Counsel independently verifies Medicare Fraud attorneys in Kailua and checks their standing with Hawaii bar associations.

Our Verification Process and Criteria
  • Ample Experience Attorneys must meet stringent qualifications and prove they practice in the area of law they’re verified in.
  • Good Standing Be in good standing with their bar associations and maintain a clean disciplinary record.
  • Annual Review Submit to an annual review to retain their Lead Counsel Verified status.
  • Client Commitment Pledge to follow the highest quality client service and ethical standards.

Find a Medicare Fraud Attorney near Kailua

The Average Total Federal Prison Sentence for Medicare Fraud in Hawaii

37.57 months*

* based on 2019 Individual Offenders - Federal Court sentencing in Hawaii federal courts. See Sentencing Data Information for complete details.

What Constitutes Medicare Fraud?

Medicare is a national health insurance program, administered under the Centers for Medicare and Medicaid Services (CMS). Medicare covers many of the healthcare expenses of enrollees. Uncovered services and remaining costs may be covered by private insurance or other government benefit programs. To be eligible under Medicare, the individual has to meet one of the following requirements:

  • Age 65 or older and a U.S. citizen, or LPR for 5 continuous years with a qualifying spouse or ex-spouse
  • Under 65 with a disability and have been receiving SSDI or other disability benefits for a qualifying period of time
  • People with End-Stage Renal Disease (ESRD) receiving continuing dialysis

Medicare fraud involves making false claims or fraudulent misrepresentations for Medicare health care benefit reimbursement. According to the Government Accountability Office, Medicare is vulnerable to fraud, with a low rate of Medicare claim audits. People accused of Medicare fraud can involve anyone involved in government healthcare benefit program, including:

  • Doctors and medical providers
  • Billing professionals
  • Health care professionals
  • Health care services companies
  • Insurance companies
  • Pharmaceutical companies

What Are Examples of Medicare Fraud?

Medicare fraud generally occurs between medical care providers and patients, vendors, or other doctors. There are several examples of medical billing fraud, anti-kickback violations, and financial gain through improper self-referral. Some common examples of Medicare fraud include:

  • Billing for services that are not necessary
  • Health care provider treatment for an undiagnosed condition
  • Charging for an unnecessary expensive service
  • Paying kickbacks for referrals
  • Unbundling medical procedures
  • Double billing or duplicate claims
  • Up-coding
  • Billing for medical services never provided

How is Medicare Fraud Determined?

There are several ways Medicare fraud can be identified. Suspected fraud can be reported by patients, healthcare providers, or even employees. Health care fraud cases can also be identified through computer analysis. CMS uses a Fraud Prevention System (FPS) to identify possible fraud. According to CMS, the FPS is a “state-of-the-art predictive analytics technology.”

The system assesses all Medicare fee-for-service claims to identify fraudulent claims and take administrative action. When patterns of inappropriate billing are identified, investigators conduct site visits, interview patients, and review medical records to identify fraud.

The Office of Inspector General (OIG) has a hotline for reporting potential fraud and Medicare abuse. Patients, co-workers, or employees may have an incentive for reporting fraudulent billing and may be eligible for whistleblower awards under some federal programs.

Is Medicare Fraud Civil or Criminal?

Medicare fraud charges can involve both civil and criminal laws and penalties. Federal health care fraud carries felony criminal charges. The penalties for a conviction of federal government fraud include up to 10 years in federal prison, or up to 20 if it resulted in serious bodily injury.

When a doctor refers a Medicare patient to another business or provider where the doctor has a financial interest, it may be a violation of the Physician Self-Referral Law, or the Stark Law. Civil penalties for illegal patient referrals include civil penalties, treble damages, and Medicare program exclusion.

The Anti-Kickback Statute is a criminal statute, with penalties including possible imprisonment for up to five years, fines, and exclusion from federal benefit programs.

The False Claims Act (FCA) provides for civil penalties where a doctor defrauds the federal government. The FCA also provides a reward system, and whistleblowers can recover up to 30% of the money recovered by the government.

Other penalties may include restitution, or paying back the victims of fraud. After a conviction for Medicare fraud, a doctor could also lose their medical license or be excluded from participating in Medicare or Medicaid. Medicare fraud may also involve other criminal violations, including:

What if You Are Accused of Medicare Fraud?

Not all Medicare fraud criminal investigations involve criminal intent. There are a number of possible explanations or legal defenses when a doctor faces fraud allegations. In many cases, suspected fraud may be caused by simple mistakes or unclear rules, without any intention of fraud. A fraud attorney can review your case for a strategic defense, with possible defenses including:

  • Accidentally putting in the wrong billing code
  • Accidentally ordering extra diagnostic tests
  • Billing employees did not have the proper training
  • Patient claimed they did not already have a procedure or test
  • Misspellings or unclear handwriting

Best Time to Seek Legal Help

No matter what your legal issue may be, it is always best to seek legal help early in the process. An attorney can help secure what is likely to be the best possible outcome for your situation and avoid both unnecessary complications or errors.

Top Questions to Ask a Lawyer

  • What is the usual process to resolve my case? How long will it take to resolve this?
  • What are likely outcomes of a case like mine? What should I expect?

An experienced lawyer should be able to communicate a basic “road map” on how to proceed. The lawyer should be able to walk you through the anticipated process, key considerations, and potential pitfalls to avoid. Once you’ve laid out the facts of your situation to the lawyer, he/she should be able to frame expectations and likely scenarios to help you understand your legal issue.

Tips on Hiring an Experienced Lawyer with Medicare Fraud Cases

The more experienced a lawyer is in legal practice, the more likely he/she will be able to bring about a successful resolution to your issue. Since experience matters, lawyers who’ve been practicing law for many years (with a successful track record) tend to be in high demand. You should look for information about a lawyer’s experience and ask questions during the initial meeting. It’s a very good idea to ask the lawyer how many years he/she has been practicing law and the expected outcome of your case.

Common legal terms explained

Pro se – This Latin term refers to representing yourself in court instead of hiring professional legal counsel. Pro se representation can occur in either criminal or civil cases.

Statute – Refers to a law created by a legislative body. For example, the laws enacted by Congress are statutes.

Subject matter jurisdiction – Requirement that a particular court have authority to hear the claim based on the specific type of issue brought to the court. For example, the U.S. Bankruptcy Court only has subject matter jurisdiction over bankruptcy filings, therefore it does not have the authority to render binding judgment over other types of cases, such as divorce.

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