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Health Care Fraud and Abuse Attorneys in NJ and NY

Defending health care providers against federal and state fraud charges

Medicare and Medicaid suffer billions of dollars per year of losses due to health care providers that attempt — or allegedly attempt — to defraud the government or private insurance companies in order to obtain additional payments. Although providers and health care institutions must remain in compliance with numerous laws and regulations, many fail to do so. As a provider or an institution, if you have been accused of fraud or abuse of state or federal laws, Buttaci Leardi & Werner, LLC is on hand to defend your rights against the federal government, state government and private insurers that seek civil penalties and criminal convictions.

No one is permitted to defraud the government

Health Care fraud is aggressively prosecuted, in both state and federal courts and before administrative tribunals. The U.S. Department of Health and Human Services has estimated that as much as 10 percent of health care spending by Medicare, Medicaid and private insurers is paid out on fraudulent claims. Most state health care criminal charges apply to false claims, self-referral, and anti-kickback laws. Federal law is far broader, covering any attempt to defraud any health care benefit program with intent to gain control of money or property. As insurance fraud defense attorneys, we have experience with a wide variety of alleged fraud claims, including:

  • Billing for medical care that was never provided
  • Filing duplicate claims for the same service
  • Altering the dates services were provided
  • Falsifying the description of services provided
  • Changing identities of members or providers
  • Failing to keep proper records
  • Accepting or giving kickbacks for member referrals
  • Waiving member co-pays
  • Prescribing additional or unnecessary treatment
  • Billing a non-covered service as a covered service
  • Modifying medical records or intentionally and incorrectly reporting diagnoses or procedures to maximize payment
  • Using unlicensed staff or selling unproven remedies
  • Using equipment improperly

Harsh penalties, serious consequences

With both civil and criminal penalties for health care fraud, providers and institutions must ensure they avoid any attempt to abuse the system. Providers have received prison sentences of up to five years (for false claims or statements) to life in prison (for an act of fraud that leads to death). Fines, which can range from thousands to millions of dollars, may be civil or criminal and will depend on whether the entity committing fraud is an individual or an institution. Improper billing, among other charges, may lead to restitution payments to insurance companies in addition to fines. This is on top of the ethical issues a provider will face, including loss of license, probation or suspension.

Discuss our health care fraud defense practice

To learn more about Buttaci Leardi & Werner, LLC’s health care fraud and abuse defense attorneys, please contact us online or call us at 609.297.5942.