Medicare Fraud Lawyer San Francisco, CA
The majority of doctors and other medical providers in California accept payments from Medicare for the services they provide to patients. In order to be allowed to do so, there are stringent requirements the government has put into place that these providers must adhere to. In order to ensure that the rules and regulations are being followed, the Centers for Medicare and Medicaid Services (CMS) will conduct audits on providers if they suspect any issues of noncompliance, such as problems with record-keeping or irregularities in billing. During a CMS audit, a provider could be accused of Medicare fraud. If this has happened to you, you need to contact a San Francisco, CA Medicare fraud lawyer immediately.
Medicare is a healthcare program created by the federal government for senior citizens 65 and over. It includes a variety of healthcare services to ensure that seniors have access to quality care regardless of their income or pre-existing conditions. Though it is mainly geared towards seniors, it also serves younger individuals with disabilities and End-Stage Renal Disease.
Providers who are suspected of violations may be contacted by the CMS notifying them that they have been chosen to be audited. An audit can be concerning to many providers, however there are ways to prepare and ensure that you go through the process smoothly. If you have been contacted by the CMS and informed that they will be conducting an audit of your practice, you likely are unsure of what this process will involve. In most cases, an audit will involve the following steps:
- The medical provider is notified in writing regarding what information the CMS is requesting. This letter is referred to as an “engagement letter.” After the provider submits the requested data, the agency will examine all the information and determine if they need any further documentation from the provider. This step can take up to six weeks before completion.
- The agency will have its auditors evaluate sample data from the information the provider has submitted. If they find any non-compliance issues, there may be additional information requested. In some cases, auditors may conduct on-site examinations. This step can take up to three weeks before completion.
- The audit results are shared with the provider, as well as any corrective action the CMS determines needs to be taken. Depending on the circumstance, the CMS may refer the case to the Division of Compliance Enforcement (DCE) to determine if any further action, including fines, sanctions, termination, or other legal steps need to be taken against the provider.
Do not hesitate to contact a legal professional if you have questions regarding any of this. He or she is trained in Medicare laws and knows what to look for in a Medicare fraud case. Your lawyer will know the best way to move forward and how to navigate in order to have a positive outcome in your case.
Medicare Fraud Conviction
If you are dependent on the Medicare program and suspect that you may be dealing with fraud, you are urged to contact a reputable lawyer who is familiar with the Medicare program and laws that regulate it. Healthcare providers and medical professionals such as physicians are expected to abide by fair and legal practices. If you believe that a medical professional conducted an illegal referral or has engaged in any other form of Medicare fraud, contact a respected and skilled lawyer right away.
As a Medicare fraud lawyer in San Francisco, CA can explain, conviction for Medicare fraud could result in harsh penalties. A person who is convicted faces up to five years in prison and fines up to $25,000. There can also be civil penalties, including up to $50,000 for each violation and $11,000 for each false claim. In addition, a person could face a fine triple what the government suffered because of the false claims issued by the Office of Inspector General.
Call Our Office for Legal Assistance
Medicare fraud lawyers can provide legal assistance to both healthcare providers and individuals who have information regarding a suspected case of Medicare fraud. Navigating the complex laws overseeing healthcare operations can be difficult, so hiring a lawyer who specializes in the Medicare program can be greatly beneficial. There are many nuances within the laws, and dealing with the issues involving government systems can pose many challenges. Doing this on your own is not recommended. Instead, leave the work to a legal professional who has the experience and knowledge to help you obtain quality legal representation and positive results.
If you are being investigated or charged with Medicare fraud, contact the Morales Law Firm right away to meet with a San Francisco, CA Medicare fraud lawyer to find out how we can help. Your medical license and your freedom could be at stake.
Four Tips to Prepare for a Medicare Audit
Nothing is more daunting than receiving a notice from the Center for Medicare and Medicaid Services (CMS) of an impending audit. The anxiety intensifies when the notification is a result of reported Medicare fraud. Anyone can file a suspected fraud notification to CMS, a patient, disgruntled employee, vendor, or another insurance company that is a secondary payor to Medicare. A qualified Medicare fraud lawyer in San Francisco, CA, at the Morales Law Firm, has helped clients prepare for such audits. Here are four tips on preparing for an upcoming CMS audit.
Review Your Policies and Procedures
It is embarrassing when employees do not know company policies and procedures. Staff are good at creating workarounds so much that they forget what the actual policy says when performing specific functions on patients. Some staff may even skip a step or two. The patient is notified of each claim submitted to CMS, and such notification contains contact information for Medicare advising the patient to call for suspected fraud. Today, patients are savvier with understanding these notices and will call Medicare if a procedure listed on the notification was not performed. Reviewing the policies with the staff will also help identify employees who are not in compliance.
Draft an Audit Strategy
Identify your strongest employees (compliance officers or quality managers are preferred) to lead the audit. Runners who can retrieve patient-specific data often requested during an inspection are also helpful to have on standby—and a go-to person to answer questions from CMS auditors. If the audit notification resulted from suspected fraud, contact an experienced Medicare fraud lawyer in San Francisco, CA at the Morales Law Firm to help you get organized.
Review Compliance Program Deliverables
If your organization was required to draft a corrective action plan after a previous CMS inspection, review the plan to ensure that each action item has been met. Be prepared to address outstanding action items that have not been resolved. Your organization should perform a root cause and formulate a plan to meet the goals.
A mock audit or tracer is a good way to prepare your staff for an audit. Identify the most current CMS program audit protocols and ask your team targeted questions to assess their readiness. Write down each area of weakness and educate the staff accordingly. If your facility has been suspected of fraud, contact a Medicare fraud lawyer in San Francisco, CA, at the Morales Law Firm for assistance.
Reasons to Hire a Medicare Fraud Lawyer
If you or a loved one were injured at the hands of a Medicare professional, it’s possible you’re entitled to compensation. Medicare errors account for many deaths and injuries in the United States, so Medicare fraud lawsuits are not uncommon. If you feel you could gain compensation through a lawsuit, you might want to speak with a lawyer. The following are some reasons to hire a Medicare fraud lawyer.
To Help You Determine Damages to Seek
Knowing what damages you can claim is one of the first things you can ask a Medicare fraud lawyer about. There are several different types of damages you may be able to seek in your Medicare fraud claim. You likely have high Medicare costs you’ll need compensation for, and that could include future Medicare costs. If you missed work while recovering, you could seek lost wages and even loss of future earning capacity. If you have mentally, emotionally and physically suffered, you may be able to seek pain and suffering. Whatever losses you have faced because of injury, a lawyer will work on your case and fight to recover your deserved compensation, pursuing the person responsible. Your lawyer can walk you through all the specific damages to help you make a determination on what would be best for you to file for. Ultimately, everything to do with your case will be up to you, but an experienced lawyer will be able to give you the very best advice on your situation and help guide you throughout the process. We will never be judgmental about whatever decisions you choose to make, but we will want to see success and will do our best to guide you in that direction.
To Work with the Insurance Company
Insurance companies can be difficult to deal with, but you don’t have to do it yourself. Working with a lawyer allows you to work with someone who can fight for your rights. Attempting to communicate with an insurance company may just leave you feeling more frustrated and helpless. A lawyer who understands their tactics and knows what strategies to counter them with is more likely to have a productive conversation with them. They are also equipped to evaluate any settlement offer given to you by the insurance company. Some insurance companies try to lowball their offers in an attempt to save money for themselves, and that’s not fair to you and others in your situation. A lawyer can work through negotiations to ensure the fairest outcome possible.
To Accelerate the Process
Whether you’re dealing with the insurance company or the other party in a lawsuit, the process can sometimes take time. With the help of a Medicare fraud lawyer, the process can be accelerated so you can gain compensation sooner rather than later. This will also take a large amount of stress off of your plate so you can move on with your life. Going through any kind of court case can be exhausting, but having a lawyer on your team makes it much easier to handle. You can trust you are getting the care you deserve and your lawyer will have lots of experience in filing cases like yours so that the process can be expedited.
To Negotiate a Fair Settlement
Negotiations can get tricky if you don’t know what you’re doing. A Medicare fraud lawyer likely has plenty of experience in these types of negotiations. If the settlement being offered is low, your lawyer can point out the reasons you deserve more. Appealing to the emotional side of the case can be difficult, but your lawyer can show why compensation is essential for those emotional scars caused by your injury. Your lawyer will be able to determine what amount a judge will think is reasonable for damages and will know what kind of arguments have been positively received in cases in the past. Your Medicare fraud lawyer may even know the judge who is presiding over your case and what his or her general policy on these types of cases. This kind of experience is more valuable than anything in a case like this.
Other Ways a Lawyer Can Help with Your Case
Medicare fraud lawyers are incredibly helpful in making sure that you get what you deserve in a case. They also take an enormous amount of stress away from the prosecuting party. By retaining the assistance of a lawyer, you are also acquiring peace of mind. You can begin to relax some, knowing that someone who is knowledgeable in the field has your best interest at heart. Your lawyer will be fighting for you every step of the way and will ensure all necessary paperwork and proof is filed for your case. You do not want to risk something as valuable as your medical license and career. You need to have someone on your side who does this every day and will know what the best arguments to use in court will be to get a favorable outcome in your case.
Contact a Lawyer Today
Taking legal action may be something that you are not comfortable doing. However, it is best that you are able to fully understand the legal resources at your disposal. It may not be too late to file a claim. If you are a victim of Medicare fraud or are a healthcare provider facing an audit, a skilled lawyer can help you.
Medicare fraud can be frustrating for several reasons, but especially because you’ve put your trust in a Medicare professional who failed you. Waiting too long to learn about your legal options regarding a Medicare fraud case can cost you the ability to submit a valid claim. You don’t want to miss out on monetary compensation that you may be eligible for. To learn about the legal services that you can receive, arrange a consultation with a lawyer as soon as you can. If you or a loved one were injured at the hands of a Medicare professional, contact our Medicare fraud lawyer today to discuss the options you have moving forward. We will speak with you about any concerns you may have and how much money you will need to invest to get representation. It is almost always worth having a keen legal eye on your case so that you have the best chance of having a favorable outcome.
How To Protect Yourself from Medicare Fraud
Medical identity theft and Medicare fraud can happen to anyone. These instances of fraud occur when someone steals your personal information and uses it to submit claims to health insurers without your permission. Staying vigilant and learning how to protect yourself from Medicare fraud may save you future headaches.
If you find yourself a victim or are accused of Medicare fraud, know that you are not alone. A Medicare fraud lawyer in San Fransisco, CA, can help you. The Morales Law Firm understands the frustration of dealing with fraud and can help you find an attorney.
Review Your Medical Claims for Discrepancies
If you frequent different medical services, keeping track of your claims may feel like a chore. However, if you track your appointments, medical records, and claims, you can have a good first defense against fraud. Note the dates and times you saw a medical provider. Keep lists of receipts and medical records from your visits.
When Medicare processes your claim, you can double-check with your evidence. Make sure all the information on the claim matches your records. If you notice discrepancies, report them to Medicare.
Sometimes, you may be accused of committing fraud. If you find yourself in that position, a medicare fraud lawyer in San Francisco, CA, can advise you on the next steps to take.
When it comes to medical services, there can be a lot of options. Some places will offer deals or incentives to get you to walk inside their doors. If a deal seems too good to be true, it may be.
There are many red flags to look out for. One could be offering free services to Medicare Patients. Another could be a provider heavily pressuring you for high-cost services. You may be billed for items that you explicitly refused. If you are worried you have been scammed, a Medicare fraud lawyer in San Francisco, CA, can help answer questions about your unique situation.
Protect Your Identity
Identity theft is a serious crime. Your Medicare number is an important personal identifier. Never give out your Medicare number to anyone other than a trusted professional.
If you get a cold phone call or email from someone asking for your number, stop communicating with them. Call the Medicare customer service line and your doctor’s office to confirm if your number is needed.
The Morales Law Firm can connect you with a trusted attorney if you feel you’ve been a victim of Medicare Fraud.
Medicare Fraud Lawyer San Francisco, CA
Medicare fraud can be devastating and that is why hiring a Medicare fraud lawyer in San Francisco, CA can be beneficial to you.
Imagine that you just got your new Medicare card in the mail and not long after you get a phone call from someone claiming to represent Medicare or the federal government. They call to claim that you have to give them your social security number to activate your new card and your bank account information. Then they might even say that if you don’t comply they will cancel your benefits.
That is just one scenario that could happen when it comes to Medicare fraud.
Types of Medicare Fraud and Scams
There are many different ways in which illegitimate Medicare spending may be carried out. No matter why or how it is done the effects of these scams and fraudulent ways can truly hurt the person who needs Medicare. Here are just some of the ways this can happen:
- Double Billing: This is when the service that was produced for, or when a product is purchased that it is deliberately charged twice even though the service was only performed once or the product was only supplied once.
- Phantom Billing: This is when a test or procedure was billed for without ever actually being performed. It also can happen with other medical services like billing for a medication that was never ordered.
- Upcoding: Upcoding happens when the codes are altered to specific billable services to reflect a higher level of service than what was actually performed. Typically this scam is carried out to receive a fraudulently higher Medicare reimbursement than what would have happened.
- Unbundling: This is when a comprehensive service is separated into several specific services and they are billed for each one independently. The goal is to have a higher reimbursement total by doing this.
- Unnecessary Services: This is when someone performs a medical service that wasn’t needed in order to receive Medicare compensation.
The Do’s and Don’ts – Tips If You Are Facing a Medicare Audit
Do Allow Access
As a provider who accepts Medicare reimbursement, you have agreed to allow CMS or its designated contractors access to your records. After you have confirmed the agency’s identity seeking access as a valid representative from Medicare, you should be as cooperative with the records request as possible. If you are confused about what the auditor is requesting, a Medicare fraud lawyer in San Francisco, CA, with The Morales Law Firm, can advise you on what records need to be provided. Your lawyer can also contact the auditor on your behalf to clarify what documents are required. If you are evasive with the auditor or look like you are trying to hide information, the auditor will be more likely to suspect fraud on your part.
Don’t Make False Statements
During the audit, you may interact with the Medicare representative reviewing your records. The auditor may have questions about the patient files and your recordkeeping system. You should answer any inquiries truthfully. If you are not sure or do not understand what is being asked, it is best to say you don’t know. If you think you may have made an incorrect statement, you should immediately contact a medicare fraud lawyer in San Francisco, CA. An attorney from The Morales Law Firm can advise you on action that may need to be taken to minimize potential damage from misleading or false statements.
Do Respond By the Deadline
It is essential to keep a dialogue open between you and the auditors during an audit, otherwise the Medicare representative may think you are being evasive. If the auditor sends a request asking for a response by a specific date, you should try to give as complete a response as possible by the deadline. If you need more time to respond, you should contact the Medicare representative to request additional time. A Medicare fraud lawyer in San Francisco, CA, with The Morales Law Firm, can contact the auditor on your behalf to agree to a reasonable time frame for response.
Don’t Alter Documentation
If you think you have a compliance issue with your existing documentation, do not change it after the auditor has reviewed it. Editing medical records after a compliance review can be considered as evidence of fraud. If you are not sure whether you may correct medical record documentation after its initial creation, contact a medicare fraud lawyer in San Francisco, CA, for advice.
How to Stay Safe From Medicare Fraud
With everything, there are ways to make sure you are safe from Medicare fraud. Know that Medicare officials will never correspond with you via phone or email unless they are responding to a request you made for them to do so. This means that if you get a call from someone claiming to be from Medicare and you didn’t put in a request that it is a scam of some kind.
Official communication from Medicare is by mail only and they will not come to your door. If someone shows up to be a sales representative then you know that they are committing fraud.
Keep track of your health treatments and include details about the kinds of tests and services that were performed. You’ll need to then crosscheck this information with your Medicare statements to make sure that they are accurate. This also means that you should be suspicious of any health care providers that tell you a service or item isn’t covered by Medicare but they know how to bill Medicare so that the program will pay. Also, keep a lookout for any health care provider that aggressively pushes a product or service you feel is unnecessary or there are alternatives.
Qualities to Look for in a Medicare Fraud Lawyer
If you are the victim of Medicare fraud, it is important to have a Medicaid fraud lawyer in San Francisco, CA on your side. However, if you have never hired one of these legal professionals before, you might not know what to look for. Here are a few characteristics to consider in a Medicare fraud lawyer.
- Specialized experience: First and foremost, it is important to hire a lawyer who has specialized experience in handling Medicare fraud cases. He or she will then have extensive knowledge about the Medicare laws in your state and improve your chances of getting a fair settlement.
- Honest: Just like with other types of lawyers, you want to work with a Medicare fraud lawyer who is completely truthful. He or she should not sugarcoat something just to make you feel better. For example, if it looks like there is not sufficient evidence to bring the Medicare professional to justice, your lawyer should tell you that.
- Compassionate: Being the victim of Medicare fraud can be very devastating. You can’t believe that someone could do something so dishonest and experience anxiety over it. That is why it is important to have a compassionate lawyer on your side. He or she should understand that you’re in a difficult situation and do everything possible to help you feel better.
- Assertive: If you wish to pursue a claim for Medicare fraud, you will have to deal with an insurance company at some point. Unfortunately, insurance companies care about their bottom line first and may try to get out of paying you what you deserve. This is another good reason to work with a qualified Medicare fraud lawyer. He or she should be assertive and not allow insurance adjusters to take advantage of you.
- Communicative. It is also important to choose a Medicare fraud lawyer with excellent communication skills. Medicare fraud can be a confusing topic, so your lawyer should be able to explain things in language you can understand. He or she should also actively listen to you and give you thorough answers to your questions.
- Available. The Medicare fraud lawyer you select should actually have time to devote to your case. He or she should update you regularly about the progress of your case and return your messages promptly.
What is Medicare Fraud?
Medicare has been a wonderful way for numerous people to receive healthcare benefits that otherwise cannot on their own. It has seen many people get the treatment they need for certain ailments and diseases that if left untreated could have had dire consequences. While Medicare has done a lot of good for quite a large number of people, there also have been some negative consequences that have resulted from this program. Medicare is run and managed by the federal government. That means that if someone is found to be abusing medicare and receiving medicare benefits when they are not supposed to, then they are abusing the system. The penalties given to those who have been found guilty of Medicare fraud can be quite harsh. If you or someone you know has been accused of Medicare fraud or if you believe the organization you work at is committing Medicare fraud, then reach out to the Morales Law Firm for legal assistance with these matters.
The federal government has many ways of investigating and tracking if someone is committing Medicare fraud. One of their most useful tools though is from people who report these cases. The government uses a reward system to motivate people to report these types of acts and has seen many people awarded compensation for offenders who have been found guilty. Medicare fraud can also be found from certain accounting and billing patterns that don’t seem to fully align. On the other side of the spectrum though are those who have committed Medicare fraud without even realizing they did. This is when it’s beneficial to reach out to legal counsel and professionals who can prove that they unknowingly did so. If you or someone you know has been accused of Medicare fraud and you unknowingly did so, then reach out to a Medicare fraud lawyer in San Francisco, CA for legal assistance for this.
Penalties for Medicare Fraud
It’s possible to face jail time if found guilty of Medicare fraud. For example, when a doctor commits Medicare fraud they may face a fine that ranges above 100,000$. This of course will depend on the circumstances and details involved with the case, but it has happened before where penalties are in the 6-figure mark. Jail time of a few years may also be sentenced. The federal government takes medicare fraud especially seriously and if you believe that you are somehow involved with medicare fraud, then it’s important to seek out professional help and guidance to navigate through.
Legal counsel with experience in medicare fraud is available. There are many lawyers out there who practice this type of law and understand how to deal with the charges and conduct their own observation and investigation into the matter. It’s important to understand that experienced professionals are out there who can assist. No one has to fight these charges alone and the Morales Law Firm can help fight these charges for a reduced penalty or dropping the charges altogether. Contact our firm today to get the help you need.
What are common examples of Medicare fraud?
You may be in a situation where you are unsure of whether the fraud is occurring. Here are a few examples that a Medicare fraud lawyer San Francisco, CA relies on knows may sound familiar to you.
- There are bills for unnecessary services. Especially if you are the patient, you may not understand all of the medical jargon on your bill and wonder what you actually needed regarding tests during your visit. You may be surprised to find out that not all of the services provided to you were necessary for your health condition.
- Being double billed. If a hospital sends out a bill twice for the same service demanding to be paid twice for the service, this could be an example of fraud.
- Providing false records. If a hospital falsifies the health condition of the patient so that they can argue for more extensive (and often more costly) types of tests, this is fraud.
- The medical provider “unbundles” their bills. Often, when a medical provider bills for services, they can expect a higher amount for reimbursement than they would for services that are bundled together. If they ask for the unbundled price by submitting improper records when they should be asking for the bundled price, this is fraud.
- Self-referring their practice. A physician cannot self-refer to their patients and this could be grounds for filing a fraud claim.
Who can I call for more information?
These are just a few examples of how fraud can occur with Medicare and if you suspect the provider you are with is committing any of these types of fraud or are concerned after you have been accused of Medicare fraud, it is time to speak with a lawyer you can trust. Contact the Morales Law Firm for more information on your Medicare fraud case.
If you have experienced Medicare fraud then talk to a Medicare fraud lawyer in San Francisco CA today to learn about what we can do for you here at The Morales Law Firm.
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