Top Huntersville, NC Medicare Fraud Lawyers Near You
Partner with the 'A' Team: Former Federal Prosecutors, FBI Agents & Army JAGs Defending the Accused in Serious Criminal Matters
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Over 35 years experience! Board Certified Specialist in State and Federal Criminal Law. Click here or call us today to schedule your FREE CONSULTATION!
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Fed Trouble? Free Consult. Former Prosecutor & Team Former Federal Agents. Call/Text 24/7. Immediate Response Guaranteed!
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We Handle All Types of Federal Criminal Cases. 15+ Years of Experience. Se Habla Español. Call Today for A Free Consultation!
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1515 South Blvd, Charlotte, NC 28203
Contact Steven T. Meier, PLLC Attorneys at Law for your Medicare Fraud needs in North Carolina.
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One Wells Fargo Center, Suite 3500, 301 South College Street, Charlotte, NC 28202
620 S Tryon St, Suite 950, Charlotte, NC 28202
101 South Tryon Street, Suite 2610, Charlotte, NC 28282
525 North Tryon St, 16th Floor, Charlotte, NC 28202
101 North Tryon Street, Suite 1300, Charlotte, NC 28246
6000 Fairview Road, Suite 1200, Charlotte, NC 28210
300 S. Tryon Street, Suite 1700, Charlotte, NC 28202
112 S. Tryon Street, Suite 720, Charlotte, NC 28202
301 S. College St, Suite 3400, Charlotte, NC 28202
Hearst Tower, 24th Floor, 214 North Tryon Street, Charlotte, NC 28202
1120 S Tryon St, Charlotte, NC 28203
201 North Tryon Street, Suite 3000, Charlotte, NC 28202
201 N. Tryon Street, Suite 2000, Charlotte, NC 28202
101 S Tryon St, Suite 3500, Charlotte, NC 28280
2820 Selwyn Avenue, Suite 818, Charlotte, NC 28209
214 N. Tryon Street, Suite 2425, Charlotte, NC 28202
201 South College Street, Suite 2300, Charlotte, NC 28244
214 North Tryon Street, Suite 3700, Charlotte, NC 28202
620 S Tryon St, Suite 800, Charlotte, NC 28202
225 East Worthington Avenue, Suite 200, Charlotte, NC 28203
One Wells Fargo Center, Suite 2900, 301 South College Street, Charlotte, NC 28202
2333 Randolph Rd, Suite 100, Charlotte, NC 28207
101 South Tryon Street, Suite 2200, Charlotte, NC 28280
225 E. Worthington Ave, Suite 100, Charlotte, NC 28203
Huntersville Medicare Fraud Information
Lead Counsel independently verifies Medicare Fraud attorneys in Huntersville and checks their standing with North Carolina bar associations.
Our Verification Process and Criteria
Ample Experience
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Be in good standing with their bar associations and maintain a clean disciplinary record.Annual Review
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Pledge to follow the highest quality client service and ethical standards.
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:
- Identity theft
- Forgery
- Money laundering
- Wire fraud
- Insurance fraud
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