Lawyers For Medicare And Medicaid Billing Fraud
Fraudulent billing under Medicare and Medicaid is one of the main targets of the False Claims Act. When medical bills are inflated or coded in ways that violate CMS rules, the government loses money, beneficiaries lose trust, and patient harm may result.
At Cross Law Firm, S.C., we stand up for individuals who see this fraud happening. Our Medicare/Medicaid fraud lawyers are nationally recognized and focus on protecting whistleblowers who report fraud across the country. With over 45+ years of experience, we are unyielding advocates and strategic problem-solvers who get results efficiently for people like you. Experience and a track record of outstanding outcomes yields respect from the Department of Justive investigating and trial attorneys for our Whisteblowerss cases.
What Is Upcoding?
Upcoding happens when a provider uses a billing code for a more expensive service than what was actually delivered. A simple example is billing for a long, complex visit when the patient only met with the doctor for a short check-in. This kind of conduct can trigger a false claims investigation and may support an upcoding lawsuit when you have documentation that shows the CPT codes do not match the service.
What Is Unbundling?
Unbundling is a scheme where providers bill for separate procedures that should be grouped under one code. For instance, instead of using one code for a cardiac panel, a clinic may bill each blood test individually to increase reimbursement. Unbundling can mislead auditors, inflate costs and violate clear Centers for Medicare & Medicaid Services (CMS) rules.
Other Common Billing Fraud Schemes
These patterns often appear in billing records. They matter because they show repeated conduct, not isolated mistakes:
- Billing for services not rendered
- Billing for medically unnecessary services
- Falsifying patient files to justify billing
- Compensating employees or others for referrals or remuneration to providers for prescribing certain drugs or device usage
- Not collecting co-pays in pharmacies or for healthcare
- Pharmaceutical fraud or all sorts, such as altering compounding ingredients, falsifying the lowest “usual and customary” when reporting to the government
- Stark Act kickback violations
- Eligibility or continuation fraud, such as in hospice settings
If you are seeing any of these patterns in your daily work, your ability to provide direct evidence is exactly what is needed to move forward. Because there are only a few attorneys nationwide who focus on these cases, other law firms often seek our Medicaid fraud attorneys to serve as co-counsel. With our experience, you can submit your sealed claim confidentially.
Call Us Today For A Confidential Case Review
Your knowledge can expose fraud, protect patients and lead to significant awards for relators under the False Claims Act.
If you believe you have proof of unbundling fraud, upcoding or any other illegal billing, Cross Law Firm, S.C., is ready to stand with you. Report illegal medical billing today. Contact us via 414-616-3229 or fill out the online contact form for a free, confidential review.