Detroit, Michigan Medicaid And Medicare Fraud Defense Lawyer

In recent years, state and federal investigators have increased efforts to curb Medicare and Medicaid fraud. As a result, overzealous prosecutors can initiate an investigation against doctors, clinics, hospitals, and medical supply companies when patterns emerge involving billing and referrals. Sometimes, in their zeal to catch those who are breaking the law, innocent health providers are swept up into someone else's misdeeds. In the process, investigators may audit a suspect's finances, office records, or tax returns looking for anything that would suggest unreported income and a pattern of fraud.

At Burdick Law, P.C., we understand how healthcare fraud investigations are conducted. If brought in early enough, we can meet with investigators, answer their questions, and diffuse or deflect further investigation of our client. We also counsel and advise doctors, hospitals, and medical suppliers in how to avoid obstruction of justice charges without incriminating themselves.

Regardless whether you've been indicted or are under investigation for healthcare fraud, contact Medicare and Medicaid fraud defense attorney James W. Burdick today.

REFERRAL FEES — KICKBACKS

Typically, investigators grow suspicious when they see what they believe is a pattern of referrals among a specific group of doctors or healthcare providers. If independent clinics are involved where doctors have an ownership interest in the practice, investigators will review referral records in order to identify what they believe is a pattern of fraud. Here, a kickback fraud investigation can involve anyone or more of the following:

  • Medicare and Medicaid fraud kickbacks from referrals
  • Medicare and Medicaid fraud kickbacks from prescribing medication
  • Medicare and Medicaid fraud kickbacks to surgeons
  • Medicare and Medicaid fraud kickbacks from medical testing
  • Medicare and Medicaid fraud kickbacks involving hospitals or clinics

In defending our clients, we work with medical experts, accountants, and private investigators if necessary in exposing the groundless assumptions of prosecutors. Here, it's often a matter of demonstrating the existence of valid medical reasons for a referral and explaining why what investigators take to be a pattern of fraud is, in reality, a working relationship among medical professionals.

MEDICAID AND MEDICARE FRAUD — OVERBILLING, OVERUTILIZATION, UNDERBILLING, UPCODING, UNBUNDLING

In most overbilling healthcare fraud cases, the Current Procedural Terminology (CPT) codes or the Healthcare Common Procedure Coding System (HCPCS) is involved. Even for a seasoned healthcare or insurance professional, the CPT and HCPCS codes can be difficult and even perilous to try to understand and master. As a result, a healthcare provider may consistently make the same kind of mistake in using CPT or HCPCS codes when billing Medicare or Medicaid. Unfortunately, to an overzealous investigator, what is in reality an honest mistake may instead be converted into a claim of a pattern of fraud: the CPT code for an initial office visit is not straight forward when the medical service provided and the length of the office visit is taken into account.

In defending our clients, we work closely with claims adjudication professionals, accountants, and physician and medical billing experts. As your attorney, James W. Burdick points to ambiguities within the CPT and HCPCS codes, explaining your actions within the framework of the treatment provided and the confusing nature of the CPT and HCPCS systems.

CONTACT DETROIT LAWYER JAMES W. BURDICK TODAY ABOUT KICKBACKS AND OVERBILLING ACCUSATIONS

If investigators have contacted you and requested information from you, contact healthcare fraud lawyer James W. Burdick today. We can help you cooperate with investigators while protecting your rights and interests.