Billing for Services Not Rendered
Representing Texas Healthcare Providers for 130+ Years
In today’s regulatory landscape, health care providers are keenly scrutinized by government agencies that aim to eliminate waste, fraud, and abuse. This is especially true when it comes to Medicare & Medicaid fraud, and especially so when it comes to billing practices and allegations of billing fraud involving claims submitted for services that were not actually rendered.
At Hendershot, Cowart & Hisey, P.C., our Houston-based health care attorneys serve a range of medical providers nationwide in matters involving proactive regulatory compliance and responsive representation when irregular billing patterns result in audits, investigations, and allegations of fraud. Over the years, we’ve leveraged our experience and resources to excel in this challenging practice area, and provide the comprehensive counsel health care clients need when it matters most.
Discuss your billing-related health care needs, from ensuring regulatory compliance to responding to audits and investigations. Call (713) 909-7323 or contact us online to schedule a consultation.
Billing Practices & Health Care Regulations
The federal government has waged a campaign of increased oversight, enforcement, and punishment in matters involving health care fraud and abuse among providers who bill for services paid for by federal health care programs – including Medicare and Medicaid, and TRICARE, the military insurance program. These efforts include a greater focus on the billing practices of physicians and providers, which can in turn result in audits and recoupment, investigations, and potential civil or criminal liability for violations.
While there are many billing practices that can constitute violations, one of the most glaring violations is billing for services that were not actually delivered. This can include billing for services not furnished, supplies not provided, or both, as well as falsification of records to show delivery of such items. When such billing issues are identified, there can be a number of implications for providers, including:
- Audits & Overpayment Recoupment – Billing for services not rendered constitutes an overpayment that becomes a debt providers owe to the federal government. Under federal law, agencies such as the Centers for Medicare Services (CMS) have the ability to recover these overpayments, often with assistance from contractors such as the Medicare Administrative Contractor (MAC) and Novitas Solutions, Inc., the CMS contractor for the state of Texas. Responding quickly and appropriately to demands for recoupment is critical, and requires strategies tailored to the unique facts at hand. This may involve options for submitting rebuttals and disputing overpayment demands through an appeal process, reaching agreements for resolution, and other approaches that aim to avoid or mitigate potential penalties, as well as any concurrent investigation that may arise in related to fraud or abuse violations.
- Health Care Fraud Investigation – Whether investigatory efforts begin as a result of analysists or auditors finding unusual billing patterns, whistleblowers, or complaints / reports to government authorities, they have the potential for serious penalties that can threaten practices and the futures of medical professionals, as well as costly and time-consuming efforts needed to comply with authorities. Should a health care fraud investigation be launched, providers may also receive subpoenas or Civil Investigative Demands (CIDs) for medical records. Experienced representation is crucial to responding appropriately to these demands, opening doors of communication for good faith negotiations, ensuring cooperation and compliance, and raising any applicable defense.
- Federal False Claims Act Violations – The federal False Claims Act (FCA) makes it illegal to knowingly submit false or fraudulent claims to the federal government for payment, and it has become one of the government’s most powerful tools in combatting fraud and punishing providers. Although it specifies the term “knowingly,” the FCA can still apply in cases where violations occur as the result of lack of due diligence, or acting in “deliberate ignorance” or with “reckless disregard.” Because the FCA exposes providers to devastating repercussions – including civil monetary fines, damages, provider exclusion from health care programs, and even criminal liability – it is absolutely crucial that FCA cases are handled by attorneys with the insight needed to effectively evaluate demands and investigations, structure response and defense strategies, and pursue the most positive resolution possible.
Due to substantial exposure to penalties created by billing fraud allegations, Hendershot, Cowart & Hisey, P.C. is prepared to respond immediately to providers who face audits and investigations. We waste no time in conducting investigations and working on your behalf.
Comprehensive Counsel for Health Care Providers
Ensuring compliance with health care regulations can be a daunting task, but it can be effectively managed with the assistance of proven attorneys. Our legal team leverages over a century of collective experience to help clients comprehensively address all facets of their practice – from billing practices and employment agreements to compensation arrangements and contractual relationships – to ensure they comply with all applicable laws, including those involving fraud and abuse under federal laws like the FCA, Anti-Kickback Statute, and Stark Law, and state law equivalents.
In addition to helping clients structure and implement sound compliance plans, we also have the depth of experience to assist clients when allegations of violations have already been made. This includes an immediate response to audits, questioning by authorities, subpoenas, and demands. As we pursue resolutions, we also work to help clients structure billing systems and other facets of their practice to ensure compliance, uncover and report overpayment when it occurs, and reduce risks for problems and potential violations moving forward.
Speak Personally with a Houston Health Care Attorney
Our attorneys at Hendershot, Cowart & Hisey, P.C. understand the gravity and immediacy inherent to complying with health care fraud and abuse regulations, and responding to issues as they arise. We are poised and immediately available to deliver the high quality service and support providers of all types need when tackling fraud and abuse-related matters in Texas and throughout the U.S.
If you wish to learn more about our services, including proactive counsel during the formation and structuring of your business and immediate handling of investigations, do not hesitate to call (713) 909-7323 or contact us online for an initial consultation.