Healthcare providers want to give their Medicaid patients the best care possible. Providing that care requires listening, observing, diagnosing, recommending, and prescribing. Each step comes with a list of other responsibilities, such as ordering tests, making referrals, reporting every detail of the patient’s care, and filing all information with Medicaid for reimbursement. Most providers take great care to remain in compliance with Medicaid’s many complicated rules, regulations, and record-keeping requirements and still, some find themselves unexpectedly under investigation for Medicaid fra ..read more

Healthcare fraud and abuse result in billions of dollars of losses each year for the federal government and private insurance companies. The ultimate cost of those losses is far-reaching, which is why the government is very committed to detecting and prosecuting healthcare fraud. Healthcare fraud is a crime under federal law, and those who violate the law will face stiff penalties if convicted. Healthcare fraud can also result in civil penalties under federal laws that prohibit making false claims to the government. A conviction on charges of healthcare fraud can be very damaging to reputation ..read more

Healthcare fraud schemes have cost the U.S. government, taxpayers, and insurance companies nearly $100 billion annually. If you think the government isn’t taking any alleged fraud seriously, – or anything that even resembles fraud – think again. According to the National Health Care Anti-Fraud Association, Medicare and Medicaid fraud has cost taxpayers hundreds of millions. How is it possible to defraud the government for medical care? Common healthcare scams in the U.S. Healthcare fraud can be big business, according to the government: dummy corporations billing Medicare and Medicaid for fake ..read more

Some people make considerable sacrifices to become a doctor – sacrifices in time, money, and effort are all jeopardized when they’re accused of anti-kickback violations. If you are under investigation or accused of violating the federal Anti-Kickback Statute, it’s in your best interest to work with a healthcare fraud lawyer from Griffin Durham Tanner & Clarkson LLC.   A strong defense will help you avoid criminal penalties and prevent loss of your medical license. Contact us online or call one of our offices to schedule a consultation. Call (404) 891-9150 for our Atlanta office or (91 ..read more

Health care fraud occurs when a medical provider intentionally submits false or misleading information for use in determining the amount of health care benefits payable. Upcoding and unbundling are forms of health care fraud. At times, innocent health care providers can be routinely accused of upcoding, unbundling, and other forms of health care fraud. If you’ve been accused of upcoding, unbundling, or some other form of health care fraud, you should contact an experienced health care fraud defense attorney immediately. In this article, we examine the practices of upcoding and unbundling.  ..read more

Penalties for health care fraud violations can range in type and severity. Over the last several years, the federal government has been aggressively cracking down on health care fraud. Health care fraud is a type of crime that involves the filing of dishonest health care claims. Anyone who is convicted of health care fraud faces serious civil and criminal penalties. In this article, we examine the penalties for committing health care fraud.   Criminal Penalties The criminal penalties associated with health care fraud are significant. A person who makes fraudulent claims as descr ..read more

Health care fraud can take many forms, but there are common types of health care fraud schemes frequently prosecuted by the Department of Justice (“DOJ”). It is also a frequent subject of False Claims Act (“FCA”) qui tam suits. FCA actions have resulted in the recovery of billions of dollars on behalf of taxpayers. In this article, we discuss the most common health care fraud schemes investigated by the DOJ.  Medically Unnecessary Services Medicare and Medicaid only provide reimbursement for procedures or expenses that are medically necessary. When medical professionals suggest procedures ..read more

If you are a health care provider who has been accused of fraud, you need to hire an attorney—and quick. However, not just any attorney will do. You must find a health care fraud defense attorney who will give you the best shot at a successful outcome in your case. Picking the right attorney can make all the difference in the world. Picking the wrong attorney, on the other hand, can make things go south quickly. In this article, we discuss how to choose a health care fraud defense attorney.   Things to Look for In a Health Care Fraud Defense Attorney When you’ve been accused of healt ..read more

A frequent question we receive from clients is: how do I know whether I am under government investigation? The short answer is: you may not know whether you are under investigation and, if you do know you are under investigation, the government may already be a couple steps ahead. By the time you learn of a health care fraud investigation, government investigators have typically been working on the investigation for a significant amount of time. While each investigation has its own unique facts and circumstances, as a general rule, government investigators and the Department of Justice (“DOJ ..read more

Health care fraud prosecutions are led by three groups of prosecutors.  Most investigations will be handled by a local U.S. Attorney’s office. In U.S. Attorney’s offices across the country, each district has a designated health care fraud coordinator to handle criminal and civil investigations. Although they are based out of specific geographic areas, U.S. Attorney’s offices can investigate health care fraud that occurs outside of their area if there is a connect to the area they work. Many offices have specialized prosecutors and teams who focus on health care fraud prosecutions. At DOJ ..read more