Billing Fraud Questions

Billing fraud happens daily – either intentionally or inadvertently. For the most part, medical insurance billing fraud is the most common. Whether you are the victim of billing fraud or accused of it, there are bound to be many questions about the legal implications and the best course of action available to you. Below are five of the top billing fraud questions that have been answered by the Lawyers on JustAnswer.

Can a sealed misdemeanor Medicaid billing fraud conviction be brought up in court on a separate billing fraud case years later?

In most cases, it can be. Sealing a file doesn't always prevent it from being used in the future, although generally it is only used in the penalty phase of a trial. There are some circumstances where it could be used in the guilt or innocence phase, but it is usually used only in the punishment phase of a trial.

I was convicted in a Medicaid billing fraud case and continued working in the same field after probation and restitution for over 25 years. Is it discrimination to be terminated because of the earlier conviction by a chain that bought the business from my employer?

You only have an action for wrongful termination if you can relate the treatment to some type of actionable discrimination. In the absence of a written agreement to the contrary, an employee can be treated differently or discriminated against for any reason, as long as the reason is not prohibited by law. Federal laws prohibit employment discrimination on the grounds of race, religion, sex, national origin, age, disability, past, current, or future military obligations, FMLA usage or filing a worker’s compensation claim. If you think that your treatment was based one of these protected areas you may have an actionable claim against your employer. To make a claim against your employer, you must file a "charge of discrimination" with the EEOC. The charge must be filed by mail or in person with a local EEOC office within 180 days from the date of the alleged violation.

If an employer is billing Medicare for services for a licensed physical therapist, but does not actually have a licensed physical therapist on staff, would this be called Medicare fraud?

This seems to be a definite case of Medicare fraud. As an employee you can also be held criminally liable for Medicare fraud if you were employed during the period when this was happening and were involved hands-on with the Medicare billing or coding. If you have questions about how you could be held liable and how to safeguard your interests, ask a Criminal Lawyer on JustAnswer. Their expert insights can help you ensure your best interests.

If a major hospital’s billing company has billed someone twice for the same dates of service and the same amount, with different patient numbers, would this be considered billing fraud?

This may or may not be considered billing fraud. If it was an honest error and the billing company is trying to rectify the situation it may be viewed as an operational error and not as an instance of fraud. Many times billing companies assign different patient numbers for different dates of service. Billing a patient for the same dates and amounts under different patient numbers could be the result of a small oversight. If that is the case, when it is reported, the billing company would try to correct their error. It would be billing fraud if it can be proved beyond a reasonable doubt that double billing was intentionally done with the fraudulent intentions.

Would the person that handles the billing for a physician from a different office be liable for double billing, if they have a verbal agreement? Would they need a written contract to protect their liability in the billing area?

In most cases, the billing party well as the physician could be held liable for billing fraud. To safeguard against this, they should have a contract with a clause that states something to the effect that "Clinician acknowledges that Biller submits bills based solely on information provided by the Clinician and has no independent knowledge of the accuracy of these bills. Furthermore, Clinician acknowledges that they are providing truthful information to Biller for purpose of billing." This makes it clear that 1) you only know what you are told and 2) the clinician is promising you everything is accurate (and if it isn't then it is at no fault of yours). If possible, include a clause of responsibility in the agreement where the Clinician takes absolves the Biller of liability as long as the bills raised are as per the information provided by the Clinician.

It is sometimes easy to unwittingly commit billing fraud, especially if you are carrying out instructions from someone who is perpetrating billing fraud. Depending on your situation, you even find yourself on the receiving end of billing fraud. The only way to safeguard your interests is to be well informed of the law. One way to ensure this is to ask a Lawyer on JustAnswer. Their legal expertise and insights can help protect your interests against billing fraud.