Grand Rapids Healthcare Fraud Lawyer

Defining Healthcare Fraud in Grand Rapids

At SBBL Law, we are dedicated to defending you against a wide range of healthcare fraud charges, including:

• Upcoding. This occurs when a healthcare provider overbills a person’s insurance company for a procedure that has taken place. In these cases, the provider will be paid a higher amount than they are actually supposed to receive. This causes an insurance company or public program to pay higher rates than they should.
• Billing for services not provided. When an insurance company is billed for a medical service, supply, or procedure that was not actually provided, this is considered billing for services not provided, and it is a type of healthcare fraud. These cases will typically involve a vast amount of falsified paperwork, which could lead to further charges. Alternatively, the provider may bill for a service they cannot bill for because they did not spend the required minimum amount of time with the patient to bill for that code.
• Kickbacks. Criminal healthcare fraud charges were brought against 193 persons across the United States recently, according to a report put out by the U.S. Department of Justice. Some of these charges involve kickbacks, which occur when there is a payment, offer, or receipt of compensation in exchange for referrals to services paid by government healthcare programs, like Medicare or Medicaid. Compensation from a kickback can include a gift or cash.
• Unnecessary or excessive services. A medical provider may prescribe excessive medical tests or medications. Sometimes, they request a certain procedure be done when such actions are not warranted. In these cases, they may be doing so to gain a profit, and the provider may be charged with healthcare fraud. This kind of healthcare fraud almost always has a tangible victim, and the patient involved could suffer serious physical harm from an unnecessary procedure.
• False diagnoses. In some situations, a healthcare provider may make a false diagnosis of their patient, which calls for specific tests and procedures billed to the patient’s insurance to gain a profit.
• Phantom billing. This is similar to billing for services not provided, but it involves receiving money for services, procedures, or tests that were supposedly administered but never actually took place. This crime often involves the falsification of medical records, which can bring about claims of other types of fraud.
• Unbundling. There are certain procedures that are required to be billed under a single billing code as a “bundle,” and when these procedures are separated into multiple billing codes, that can result in overbilling the insurance company.

Healthcare fraud is one of the most complex areas of fraud in Grand Rapids and beyond. In an area bursting with a vibrant and nationally renowned medical industry, many providers find themselves the subject of healthcare fraud allegations. During these times, it is crucial that you work with an attorney who knows how to defend against these accusations effectively.