What Can Happen if I am Accused of Billing Fraud in New York?

Doctors are held to a high standard because of the services they provide their patients with. When they provide these services, patients are charged with medical bills. It is important that doctors charge the correct price and do not take advantage of their patients by overcharging. In the event that they do, it can result in billing fraud. When facing these situations, doctors should retain the services of an experienced medical defense attorney to defend their case. 

What is Billing Fraud?

When a patient receives a medical bill for a procedure, they can usually expect a certain price. However, there are many cases in which they are presented with a cost that is higher than normal. This may also be noticed by a third party, such as an insurance company. Sometimes, this may simply be a mistake. Other times, it can be the result of billing fraud. This occurs when a doctor overcharges their patients.

When a doctor commits billing fraud, an insurance company may choose to audit the individual and their office to find out more about the matter. When audits are conducted, a doctor may be found responsible for taking advantage of a patient. There are two different types of billing audits: a prospective billing audit and a retrospective audit. A prospective audit is conducted by someone in the staff who is assigned this role before the claims are submitted by the patient paying. A retrospective audits occur after the claim is submitted and the errors are identified. 

Consequences of Billing Fraud

When a doctor is audited for billing fraud, it can result in certain consequences if they are found guilty. These can be imposed by the Office of Professional Medical Conduct (OPMC) in order to penalize the individual for their actions. These consequences can severely impact a medical career as well as their life. While the doctor may not lose their medical license over the matter, they may be required to pay back large sums of money to avoid further charges. This can affect their reputation as a professional in the future, causing them to lose patients as a result. 

Contact our Firm

When a medical professional is accused of misconduct, it is essential that they retain strong legal representation. If you require a medical law attorney for your legal matters, call Paul E. Walker, an experienced New York City OPMC & OPD Lawyer. Please contact the Walker Medical Law firm to set up a free initial consultation.