Healthcare License Defense: When You Use the Wrong Insurance Codes

Posted by Joseph D. Lento | Jan 08, 2024 | 0 Comments

In the medical profession, things are always changing. You have new technology, new patient protocols, new standards of care, new treatment plans, new insurance plans, and new insurance codes. Keeping it all straight can require hundreds of hours of work and sometimes an entire staff of administrators for even the smallest medical practice.

Unfortunately, when a mistake happens in medical billing, the healthcare provider may often face the consequences, including civil and criminal penalties. You could also face disciplinary action from your state licensing board. A misplaced number, an administrative mistake, or a misunderstanding could risk your professional career. So, if you're facing accusations of medical coding fraud, you'll need the experienced Professional License Defense Team from the Lento Law Firm to help you from the beginning. Call 888.535.3686 or contact us online to schedule your consultation today.

Medical Coding Fraud

Every service you provide to a patient is billed to insurance, Medicare, or Medicaid with a “Current Procedural Terminology” code or “CPT code.” Every CPT code you use must be well documented in the patient's file, including any exam or procedures performed and the time and complexity of each visit. If a medical provider uses a CPT code for a higher level of service than the patient received, it may be considered fraud.

If you submit an incorrect claim code to a government agency, you can inadvertently violate the False Claims Act, a federal anti-fraud law. Under the False Claims Act, submitting claims that you know or should know are false or fraudulent to Medicare and Medicaid is illegal. Penalties range from $11,000 in fines per claim plus three times the government program's losses. You could also face criminal fraud charges.

However, often mistakes on CPT billing codes are inadvertent. A new administrator or medical biller could use the wrong code before submitting a bill to insurance. Or a typo could result in a higher level of reimbursement than necessary. You could face serious consequences if someone reports this to your state licensing board. Even if it was truly a mistake, you may still have to go through the investigative and hearing process, with the possibility that you'll be found responsible. You could face a reprimand, fines, suspension, or revocation of your license.

You Need the Professional License Defense Team at the Lento Law Firm

The consequences can be severe if you're facing an allegation of medical billing fraud. You may be tempted to try to handle an investigation yourself. After all, if you have nothing to hide, the truth will be clear, right? Unfortunately, that's not always the case. You shouldn't risk your career in the process.

An investigation from a healthcare licensing board, government agency, or the police can destroy your personal and professional reputation. You need the Lento Law Firm's skilled Professional License Defense Team to protect your rights. They've been defending licensed medical professionals like you for years. Find out what they can do for you too. Call the firm at 888.535.3686 or contact them online today to schedule your consultation.

About the Author

Joseph D. Lento

"I pride myself on having heart and driving hard to get results!" Attorney Joseph D. Lento has unparalleled experience fighting for the futures of his professional clients nationwide. With unparalleled experience occupying several roles in the justice system outside of being an attorney, Joseph D. Lento can give you valuable behind-the-scenes insight as to what is happening during all phases of the legal process. In the courtroom and in life, attorney Joseph D. Lento stands up when the bell rings!


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