Florida Upcoding Lawyer

Upcoding is a form of healthcare fraud that involves submitting insurance claims with codes that describe more severe or complex services than those actually provided. This practice can lead to higher reimbursements from Medicare, Medicaid, or private insurance companies. While upcoding may seem like a minor billing adjustment, it is a serious offense with significant legal ramifications. Healthcare providers, including doctors, nurses, medical billing professionals, and hospital administrators, can face severe penalties if found guilty of upcoding. Get help today by contacting our Florida upcoding lawyers for smart and strong criminal defense.

When faced with charges of healthcare fraud such as upcoding, it is critical to understand the nature of the charges against you and mount a vigorous defense. The attorneys at the Baez Law Firm take the time to understand and explain your situation, explore your options, and chart a path toward a successful resolution of the charges against you.

Legal Consequences of Upcoding

In Florida, upcoding is prosecuted under federal and state laws, including the False Claims Act, the Health Care Fraud Statutes (18 U.S. Code § 1347 and Florida Statutes 456.0635), the Anti-Kickback Statute, and more. The penalties for upcoding can be severe and may include:

• Criminal Charges: Upcoding is considered a form of healthcare fraud, which can result in felony charges. Convictions may lead to imprisonment, heavy fines, and a permanent criminal record.
• Civil Penalties: Under the False Claims Act, violators may be liable for civil penalties, including treble damages (three times the amount of the fraudulent claims) and additional fines.
• Administrative Sanctions: Healthcare providers found guilty of upcoding can face exclusion from federal healthcare programs, such as Medicare and Medicaid. This can severely impact a provider’s ability to practice and generate revenue.
• Reputation Damage: Beyond legal penalties, an upcoding conviction can severely damage a healthcare provider’s professional reputation, leading to a loss of trust among patients and peers.

Common Examples of Upcoding

Upcoding can occur in various forms, including:

• Inflating Diagnosis Codes: Using codes for more severe diagnoses than those actually treated.
• Exaggerating Time Spent: Overstating the amount of time spent on patient care to justify higher billing rates.
• Using Higher-Paying Codes: Selecting codes for services or procedures that pay more than those actually rendered.

Defending Against Upcoding Charges in Florida

If you or your practice is facing allegations of upcoding, it is crucial to seek legal representation from an experienced healthcare criminal defense attorney. At The Baez Law Firm, we understand the complexities of healthcare billing and coding regulations and are dedicated to protecting your rights and livelihood. Our approach to upcoding defense starts with a thorough investigation. We conduct a detailed review of the allegations, examining medical records, billing documents, and other relevant evidence to identify inaccuracies and build a robust defense. When necessary, we collaborate with medical billing experts who can provide insight into proper coding practices and refute claims of intentional fraud.

Our legal representation may include filing motions to get charges reduced or dismissed based on procedural deficiencies, legal errors, or even constitutional violations by the law enforcement agencies involved in investigating or prosecuting the case. In situations where a settlement is in your best interest, we negotiate with prosecutors to minimize penalties and avoid criminal convictions. If your case goes to trial, we provide aggressive defense to challenge the prosecution’s evidence and secure the best possible outcome.

Facing upcoding allegations can be overwhelming, but you do not have to navigate this challenge alone. Our law firm is committed to defending healthcare providers in Florida against charges of upcoding and other forms of healthcare fraud. We understand the stakes involved and will work tirelessly to protect your rights, reputation, and career.

Contact The Baez Law Firm to Defend Against Upcoding Charges in Florida

If you are under investigation or have been charged with upcoding in Florida, contact our office today for a free consultation. We will review your case, explain your legal options, and develop a strategy tailored to your specific circumstances. Our goal is to achieve the most favorable outcome possible, allowing you to continue providing quality healthcare services to your patients. Call 800-588-BAEZ or contact us online to protect your rights and get the best shot at a positive outcome in your case.