LibertyBell Law Group's lawyers say that, unfortunately, what raises a red flag in criminal investigations is often the most productive physician. Federal and state investigating agencies use statistical analysis software that analyzes medical billing data for averages, such as means and medians. A spike in billing claims by a doctor or healthcare professional or consistent above average Medicare or insurance claims can trigger an investigation by one of the state or federal agencies. Some agencies are monetarily motivated to look for any "suspicious" activity as they receive a percentage of the recovery for any case won.
Defense of Healthcare Fraud
federal defense lawyers from LibertyBell Law Group know that a spike in productivity in a doctor's office can be attributed to countless possible reasons, such as a successful marketing campaign or new and updated treatment methods. The fact is that humans today live longer and are healthier than they have ever been due to better healthcare and awareness. Lawyers know that when a physician, chiropractor or healthcare professional is being investigated for making false billing claims and fraud, the numbers output by software cannot and will not give a complete picture. There are many factors that must be considered and can be used by lawyers in federal defense of healthcare fraud cases, such as improved treatment methods, a busy physician, a more effective physician, and much more.
The healthcare industry is constantly evolving in response to new research, equipment, and methods. Often times, investigating agencies compare present data to past data, sometimes as far back as 10 years ago or more. Lawyers from LibertyBell Law Group know there are things that simple numbers cannot communicate and which investigators may overlook. For instance, an uptick in patient office visits could result in better long term care and healthy patients because doctors are closely monitoring and making adjustments to a customized treatment plan as they encounter individual differences and responses.
If you are being investigated for healthcare fraud, making false insurance or Medicare/Medicaid claims, falsifying or increasing E/M codes, it is imperative you protect yourself and your reputation and contact our attorneys immediately and call 855-LAW-PRO1 (855-529-7761) now.