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103 Carnegie Center, Suite 323, Princeton, NJ 08540
Call for Consultation 609.297.5942 609.297.5942

sub-medicare

NY and NJ Medicare and Medicaid Compliance Attorneys

Direction for the complexities of federal health care programs

At Buttaci Leardi & Werner, LLC, we’ve long believed that it’s imperative to have sophisticated, experienced counsel for addressing the complexities surrounding Medicare and Medicaid. As attorneys, we’ve seen the dangers of — and defended clients against — charges of fraud, abuse and other wrongdoing from the U.S. Department of Justice (DOJ), the U.S. Department of Health and Human Services (DHS), the Centers for Medicaid and Medicare (CMS), and numerous other federal and state agencies with oversight of these programs. With the increased directives instructing these agencies to eliminate fraud and waste, the targets are health care providers, practice groups and institutions that are intentionally — or unintentionally — abusing the system.

A full-scale Medicare and Medicaid practice

With a unique focus on health care law, we work with health care providers, facilities and similar clients in navigating the regulations and laws regarding Medicare and Medicaid. This includes coverage issues, reimbursement and regulatory compliance. The need for active, experienced attorneys in Medicare and Medicaid situations has arisen with the growth in Recovery Audit Contractors (RAC) — companies that operate on contingency fees and percentage payments from the government in order to recover money from overpayment and fraud. Regardless of your role — provider, accountable care organization, hospital, long-term care provider, clinic or otherwise — we work with you to create reporting systems and payment claim and government compliance programs while providing strategic advice to ensure that your profits (and your practice) are protected.

Fraudulent Medicare and Medicaid claims are actively pursued

Beyond contractors such as RACs, each state has a Medicaid Fraud Control Unit (MFCU) that is tasked with aggressively rooting out fraud by service providers. Comprising criminal investigators, auditors, practitioner investigators and prosecutors, MFCUs can not only criminally prosecute, but they can also request that providers and entities be barred from federally funded programs. The fraud that MFCUs and similar agencies and investigators look for include:

  • Billing for services, drugs, supplies or equipment that were not furnished, or were of lower quality
  • Substituting or misrepresenting the items billed
  • Billing repeatedly for purportedly covered items that were not actually covered
  • Ordering unnecessary services
  • Coding incorrectly
  • Making unnecessary additional appointments
  • Using unauthorized suppliers
  • Providing a set amount of services based on time and then overbilling
  • Billing for office visits that didn’t actually occur
  • Paying kickbacks
  • Committing medical identity theft

Contact us for support

Buttaci Leardi & Werner works with providers and entities throughout the health care space. Please contact us online or call 609.297.5942 for assistance if you’re dealing with an investigation or probe or putting a compliance and detection program into place — or for any other health law reason.