Medical Billing Fraud Defense Attorneys

Accusations of billing fraud can threaten your whole practice. When facing them, you need proven billing fraud defense attorneys committed to protecting your best interests. Our team at Cogdell Law Firm is ready to bring over four decades of combined experience to fighting the charges you face.

Since 1988, our Houston firm has advocated for clients in East Texas, North Texas and statewide. Our founding lawyer, Dan Cogdell, is well-regarded throughout the legal community. We provide steadfast defense representation to medical professionals accused of illegal billing practices — no matter how high-profile or high-stakes your case might be.

Have you been accused of medical billing fraud? Cogdell Law Firm can help. Call 713-426-2244 or reach out to us online.

What Is Billing Fraud?

Billing fraud involves illegally overbilling private health insurance companies or government health programs, such as Medicare or Medicaid. It can take many forms, including:

• Upcoding: Billing for a higher-cost code than the treatment that was actually given
• Unbundling: Separating a single service into multiple codes to charge more
• Phantom billing: Charging for services or equipment that were never provided
• Double billing: Making multiple claims for one service
• False invoices: Submitting fake invoices to support a fraudulent claim
• False diagnoses: Providing an incorrect diagnosis to justify unnecessary services

Our billing fraud defense attorneys stand ready to fight for you if you are facing allegations of any of these types of conduct.

What Is Upcoding?

Upcoding occurs when a medical provider uses billing codes for more severe diagnoses or more expensive procedures than those provided or prescribed. It is considered a form of health care fraud and can have severe legal consequences.

In the defense context, understanding upcoding is crucial. Often, health care professionals may not be aware that their billing practices constitute upcoding. The medical provider could make a simple error or misinterpret complex billing codes rather than engaging in deliberate fraud. Defending against upcoding allegations involves demonstrating that any coding errors were unintentional; showing a lack of intent to deceive can improve your legal position.

Examples of upcoding include:

• Code inflation: Using a code for a more complex and expensive diagnosis than the one identified.
• Unbundling: Billing separately for procedures that are normally covered under a single comprehensive code.
• Miscoding: Assigning codes that do not reflect the services performed, often to achieve higher reimbursement.

Our defense strategy typically involves a thorough review of medical records, billing practices and administrative processes to identify and rectify any genuine errors.

How Can Billing Fraud Be Tied to Medicare or Medicaid?

At all levels, the government treats Medicare and Medicaid billing fraud harshly. Similar to upcoding, government-program billing fraud involves seeking reimbursement for services or supplies that were never provided, unnecessary or of lesser quality than what was billed. Since these activities divert resources from legitimate patient care while burdening taxpayers, the government aggressively pursues prosecution. It can include:

• Phantom billing: Charging for tests or services that were not provided.
• Kickbacks and referrals: Receiving or giving incentives for patient referrals for unnecessary services.
• Billing for unnecessary services: Performing and billing for tests or procedures that are not medically necessary.

A successful defense requires demonstrating that you acted in good faith and within the bounds of established medical-necessity guidelines. It is vital to gather evidence showing that services billed were provided, necessary and supported by patient records and medical documentation.

What Should You Do When Under Investigation for Improper Billing?

Discovering that you are under investigation for this type of medical fraud can be alarming. However, there are steps you can take to protect yourself, your company, and your future:

• Understand your options: Knowing the full picture of each option's potential implications can help you make informed decisions.
• Safeguard evidence: Do not modify or destroy evidence, as it could expose you to even more problems.
• Cooperate: Avoid behavior that could be seen as obstructing the investigation.
• Be careful what you say: Careless talk with investigators could put you at a major disadvantage moving forward.

Navigating billing investigations can be difficult. Given this, it can be extremely important to promptly contact a skilled billing fraud defense attorney who can advise you on how to proceed and avoid making the situation worse.

Billing Fraud Accusations Can Have Life-Changing Consequences

Authorities do not take billing fraud lightly. There are many federal and state laws prohibiting such practices, and accusations of violating them can expose you to severe criminal charges. Your freedom, reputation, license and career opportunities could all be in danger. Acting fast is crucial — turn to our billing fraud defense attorneys for the strong, proactive support you need.

The Dependable Billing Fraud Defense Attorneys You Need

Who you entrust your defense to when facing billing fraud allegations is a big decision. Protect your future by choosing billing fraud defense attorneys who are:

• Experienced: Our health care defense lawyers’ powerful advocacy is grounded in over 40 years of combined legal experience.
• Dedicated to serving you: Our billing fraud defense attorneys can help with every phase of your case, from answering initial questions to guiding you through investigations to fighting charges.
• Fearless: You want advocates who will stand up for you, no matter how big the stage, how powerful the opponent is, or how complicated the circumstances are. Our steadfast billing fraud defense attorneys are not afraid to tackle even the most difficult cases.
• Trial Ready: Our billing fraud defense attorneys are at home in the courtroom. Attorney Cogdell is well-known for his tenacity at trial and his track record of big wins.

When you need a team you can count on, our billing fraud defense attorneys are here for you.

Put Our Billing Fraud Defense Attorneys On Your Side Today

You don’t have to face this tough situation on your own. Let our billing fraud defense attorneys guide you forward, stand up for your rights and pursue results that protect your future. Reach out to us today about your defense needs by calling 713-426-2244 or by emailing us.