What Is Health Care Fraud? November 24, 2019

Health care companies receive millions, if not billions, of health insurance claims for affordable and quality care. It has been revealed that a small percentage of these annual claims are fraudulent. However small the fraudulent claims, the government loses lots of money because of it. This criminal offense is the reason for the rise of health care fraud attorneys.

Who commits health care fraud?

A majority of health care plan holders and health care providers are culpable. Examples of health care providers are dentists, doctors, pharmacies, and the likes. Even worse, people who willingly give out their insurance information may fall victim of health care fraud since their identity has been compromised. Such individuals may hire a health care lawyer if they are innocent. Check here!

Types of health care fraud

As health care fraud involves dishonest individuals, culprits are likely to devise many ways to commit this crime. From hacking into medical records to duplicating procedures and submitting false claims, health care fraud varies in type.

The NHCAA, an acronym for National Health Care Anti-Fraud Association, categorizes health care fraud accordingly:

Health care providers commit frauds through:

  • Fraudulent medical billing, especially overcharging for excess services
  • Phantom billing – Billing medical procedures that were not performed
  • Prescription drug fraud – Concocting false diagnosis to justify unnecessary tests
  • Upcoding – Misrepresenting covered procedures as uncovered ones

Patients commit frauds when they:

  • Fill claims for prescriptions or medical procedures they didn’t receive
  • Forge health care bills to get reimbursements
  • Falsify their identity by using a fake insurance card
  • Peddle prescription drugs

Penalties and consequences of health care fraud

Health care fraud attorneys, according to the Health Insurance Portability and Accountability Act (HIPAA), may regulate the consequences of violating health care insurance claims. By confirming the criminality of the act, the HIPAA will prosecute offenders accordingly. If found guilty, the offender could face drastic consequences ranging from substantial fines to jail time. If the crime has led to the death of a patient, the offender may serve life imprisonment in federal prison. Other penalties include probation, loss of medical license, criminal charges, and seizure of assets, to mention a few.

Avoiding health care fraud

It is pertinent to prevent health care fraud since naivety is not an excuse in the court of law. A cankerworm in health care infrastructure, big agencies such as the FBI and FDA are adequately cracking down on health care fraud. Hence, everyone must avoid it by carrying out the following:

  • Stay informed – You must be aware of every medical procedure you’re entitled to, and document procedures for future purposes.
  • Protect health care credentials – Safeguarding your ID starts with preventing the illegal use of your insurance cards. Since your identity can be used to seek medical services and peddle prescription drugs on the internet, you have to ensure your card is protected at all times.
  • Report fraud – If, at any point in time, you detect fraudulent health care activities, inform your health insurance provider immediately. And endeavor to report card or identity theft to law enforcement officials, as well.

Sometimes, health care frauds are difficult to understand without proper guidance. In case you’re suspicious of a scam, a health care fraud attorney or health care fraud lawyer can represent you in court. Click here for more information:

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Which Medical Mistakes Cause Brain Injuries at Birth June 11, 2019

Injuries at birth can change a child and the family’s lives forever. Sometimes around the clock care is required for some children who suffered injuries at birth. This is especially true in those cases that involve brain injuries. In many of these cases, the family will be a setback in lifetime expenses running into millions of dollars. There are several circumstances that can lead to a brain injury at birth. A health care lawyer can help you in this kind of situation. Common mistakes that can lead to brain injuries include the following.

Medication Mistakes Involving Pitocin

During the delivery process, there are some medications that can lead to brain injury in the child. For instance, if the medical practitioner gives too much Pitocin (the synthetic form of oxytocin usually used for contractions inducement) or does not monitor the reaction of the mother to the drug. This could cause the mother to experience excessive uterine contractions. This can cut oxygen supply to the baby, leading to brain damage. An experienced health care lawyer can help you in this case.

Hypoxic-Ischemic Encephalopathy (HIE)

HIE occurs when there is a disruption in blood and oxygen flow to the child’s brain. The areas affected in the brain and the severity of HIE vary. One way to treat this is with cooling therapy. This helps to cool the body and head of the baby to slow the brain damage progression. The baby may suffer more significant brain damage if the HIE is treated incorrectly or not treated timely. Click here.

The Compression of the Umbilical Cord

There are certain complications with the umbilical cord that can lead to brain injury. The newborn may not receive enough nutrients and oxygen from the mother when the umbilical cord is compressed. If the compression in the umbilical cord is not resolved or treated timely, the child’s brain can suffer cellular damage.

Maternal Infections

There are certain maternal infections such as those caused by Group B Streptococcus (GBS) or Cytomegalovirus (CMV) that may lead to brain damage in an infant. GBS increases the chance of passing the infection to the baby by 2% if left untreated. The risk is even higher in those cases where the mother has a high temperature during labor or the baby is born prematurely. Depending on the onset, the symptoms of the infection can vary. However, maternal infections may lead to sepsis, meningitis, as wells other complications.

Improper Use of Delivery Tools

There are instances where babies are delivered with the help of a vacuum device or forceps. Using these tools incorrectly or in less risky procedures can cause brain damage. For instance, if too much force is used when using these tools, the infant may suffer brain injuries. Vacuum tools or forceps may lead to skull fractures, intracranial hemorrhaging and other poor outcomes when used incorrectly.

There are several other adverse health conditions mothers and their babies may experience during childbirth. The newborn may suffer brain damage if mistakes are made while treating these conditions or failing to provide medical attention time. Hiring an experienced health care lawyer or health care fraud attorney can help you fight for those children or families who have suffered birth injuries at the hands of negligent medical staff. Click here for more information:

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How Will You Pay a Medical Malpractice Lawyer? January 24, 2019


For a patient thinking about a restorative negligence claim, a foremost inquiry may be, “How much will enlist a lawyer cost me?” The appropriate healthcare may be very reassuring for some patients who have endured damage through the arrangement of inadequate health care.

Normal Medical Malpractice Fee Arrangements

Most restorative misbehaviour lawyers use possibility expenses. At the point when a lawyer utilizes a possibility charge, the lawyer’s whole expense is paid as a level of the honour or settlement for the situation. In this way, if the case goes to preliminary and the patient loses, the lawyer is never paid an expense. The segment of the honour that goes to the lawyer can shift, however, the most widely recognized unexpected charge is 33% of the honor or settlement. A few courses of action may utilize diverse numbers for various conditions. For instance, a course of action may accommodate a 33% unexpected expense if the case settles before preliminary or a 40% unforeseen charge if the case goes to preliminary.  Another issue is who pays the expenses of the case, which can be significant. These costs incorporate the expense of contracting a specialist witness, court documenting charges, and the expense of acquiring medicinal records from clinics. Numerous lawyers use assertions that give that the lawyer will pay for expenses of prosecution, in any event at first.

Essential Considerations for Patients

The essential thing for each patient to recall is this present: attorney’s expenses are debatable. If you are thinking about enlisting a specific lawyer, you ought to ask yourself, “For what reason am I procuring this lawyer?” “Is this the best, most experienced lawyer?” “Would an alternate lawyer offer a superior cost?”  For what reason doesn’t each patient counsel five unique lawyers and thinks about costs and capabilities? Even though patients, for the most part, don’t do it, there is no motivation behind why patients with potential medicinal negligence cases ought not to search for attorneys. Keep in mind, starting discussions are commonly free. Click here.

Not exclusively is the charge rate debatable, however, different terms are additionally debatable. For instance, a lawyer may propose an assertion that requires a patient to pay for case costs as they emerge. In that circumstance, the patient should seriously mull over taking part in a touch of bartering, telling the lawyer that better terms are likely accessible somewhere else, and that it would be ideal if the lawyer dealing with the expenses of prosecution “in advance,” with the understanding that those expenses would be repaid to the attorney if the offended party gets a judgment or settlement grant in his or her support.

Administrative Efforts to Affect Medical Malpractice Fee Arrangements

Some restorative negligence change savants have contended that vast possibility expenses help drive up the expense of healthcare. Therefore, a few states have passed laws confining possibility expenses in therapeutic negligence cases. A portion of these states incorporates California, Florida, Connecticut, Tennessee, and Wisconsin. The subtleties of the laws that have been passed differ, yet a portion of the laws are exceptionally straightforward. A law may just top attorneys’ charges at close to 1/3 of the measure of the honour or settlement in all restorative negligence cases. Different laws are progressively confounded. For instance, a California law goes in 2002 restricted attorneys’ expenses in medicinal misbehaviour cases to 40% of the first $50,000 recouped, 33% of the following $50,000, 25% of the following $500,000, and 15% of any sum over $600,000.


Despite the administrative structure in some random state, it is imperative for the patient to recall that expenses are debatable. Regardless of whether charges are topped by resolution, a patient is qualified for arrange a lower expense as long as related to healthcare. Check out this site:

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Health care providers face substantial legal challenges under the Affordable Care Act(ACA). Sweeping reforms have created a demand for health care law specialists. As a result, it is the fastest growing law practice in the United States.The current environment requires a renewed focus on the part of health lawyers. Health care lawyers must understand what is happening in the administrative, ethical and legislative components of the health care field to perform proficiently.The following five laws highlight a few of the most recent and significant game-changing regulations in the health care field.



The Emergency Medical Treatment and Active Labour Act took effect in 1986 with congressional sanction. The law requires care providers to deliver medical services despite the patients’ ability to pay specifically emergency services. If an individual has a medical emergency, such as an injury or active birth, the law makes it obligatory for caregivers to stabilize the patient and provide treatment up to the point where the client is stable. If the care provider cannot deliver this service, the law mandates that the provider transfer the patient to a capable facility.



The Stark Law prohibits care providers from referring a patient to a peer or family member but does provide for specific exceptions.This law applies to civil cases and exposes violators to False Claims Act culpability. The Stark Law encompasses referrals to primary care providers for specific health services and does not require prosecutors to prove intent for overpayments. However, prosecutors must prove intent for intentional violations involving punitive recovery. See more.



This was created to promote effective technology implementation among care providers. It addresses privacy and security of electronic health records. The act also reinforces parts of the civil and criminal sections of the Health Insurance Portability and Accountability Act (HIPAA).HITECH outlines four liability levels, each with increased punishments. Offenders who violate the law unknowingly, initially receive the lowest fine and the opportunity to correct the offense in 30 days to avoid fines completely. The minimum penalty increases greatly between each level.The maximum fine amounts to $1.5 million. The health care fraud attorney handles this.



Genome sequencing and other scientific developments have enabled researchers to produce incredible medical breakthroughs. While certain gene identifiers do not reveal ethnicity, some genetic traits emerge only among specific ethnic groups. Since discrimination occurred, the federal government created the Genetic Information Non-discrimination Act to prevent employers and insurance agencies from discriminating against individuals based on genetic testing outcomes. It forbids health insurance and employment discrimination based on genomic information.



Health care innovation moves at such a tremendous pace that even the most legally sound care providers have difficulty keeping up with legal issues. As care providers settle in with new payment models, they will demand more health care legal professionals to keep organizations up-to-date and compliant with the law. Check out this site:


Take A Break from the Negative Effects of Health Care Fraud September 27, 2017


Fighting health care fraud as a fulltime job can be a taxing.  Fighting to recoup money lost through waste, fraud and abuse has been the aim of the Health Care Fraud and Abuse Control (HCFAC) program since it began twenty years ago.  Through their capacity to fight using powerful tools and alliances, they have been successful in winning judgements, settlements, and impositions in many cases, and have returned more than $31 billion to the Medicare Trust Funds.  This would not be possible without cooperation between the government and the private sector.  If fighting health care fraud is your goal as a health care attorney, taking good care of yourself is just as important as catching the cheats working around the country to steal taxpayer’s money.

health-care-Pouring over evidence, interviewing witnesses, and flying around the country can be demanding work.  It’s rewarding when your team gets a judgement in your favor, but you must take care to spend some downtime and do it in a place that allows you to unwind and recharge so you can live to fight another day.  RIU Resorts offers the ideal setting for such breaks.  They have a group of all-inclusive packages that covers everything from your accommodations to meals.  Just imagine yourself on a sandy beach with the sun setting over the Pacific Ocean in RIU Mazatlán while you take in the view from the balcony of your suite.  This is not the end of a day chasing leads, it’s the end of a week of ecstasy.   And when you use a Groupon promo code celebrating RIU’s 20th anniversary, you’ll realize savings sure to help you clear your mind of all the arguments back and forth about culpability.  Getting away from the daily grind is good for your health.  You want to be strong enough to fight another day for others, so you’ve first got to be mentally and physically strong enough yourself.   Replace memories of a stress filled day in court with memories of long walks along sandy white beaches, cocktail hours, superb dining, and entertainment.

There’s been lots of research about the positive effects of negative ions on the human body.  Negative ions naturally occur when you’re near moving bodies of water, like the ocean.  There, the negative ions trap pollens and pollutants and cause them to drop out of the air you breathe.  Just like the oceans effect on the negative ions at the beach, RIU can have a positive effect on you.  They have enough freshwater pools, and sandy beaches to rid you of the negative effects in the air and the courtroom.

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6 Ways Health Care Directives Fail November 7, 2016

Health Care Directives

As mentioned by most health care lawyers, one of the most important pieces of a person’s estate plan is the Health Care Directive. Simply put, the Health Care Directive (or HCD for short), spells out how a person wants to be cared for when they become disabled. I say when they become disabled, because people are six times more likely to become disabled than die in a given year. We will all be disabled at one point; it could be the last 20 minutes of our life or the last 20 years.

Because of the risks of disability, it is wise to have your health care wishes legally stated. This is where the Health Care Directive comes into play. The HCD will state the treatments or procedures you would like once you become disabled. Additionally, the HCD will state the treatments or procedures you would not like. In fact, stating what you would not like may be just as important.

Since it is such an important document, the HCD should be reviewed every three to five years. Just like a Will or a Trust, the HCD may need to be updated. Here is a list of six ways that Health Care Directives fail:

1. Not in Doctor’s Hands (Accessibility) –When the time comes for you to use your Health Care Directive, you may not be conscious. If that’s the case, you will want your HCD to be in your doctor’s hands when you arrive at the hospital. In fact, this is a simple step that many people do not take, which can lead to your wishes being dismissed when a new HCD is created (see #6).

2. No HIPAA Authorization – An incredibly important document that should accompany your Health Care Directive is a HIPAA Authorization. HIPAA stands for the Health Insurance Portability and Accountability Act. This document authorizes other Loved Ones to receive updates on your treatment status. If you are an elderly parent, you may want your adult children to know about your health.

3. Not Properly Written – A Health Care Directive that is poorly written will not get better with age! Different people want different options when it comes to deciding their healthcare choices. Usually a “template” HCD cannot offer these choices.

4. Wrong Parties – The people whom you designate on your HCD should actually be the people you want to make decisions on your behalf. Surprisingly, I have seen many HCDs that spell out the wrong people (or parties).

5. Old / Out of date – What happens when the person you designated as your Agent seventeen years ago has already passed away? Or what happens when your Agent has moved to California and won’t be able to travel to Minnesota? An out of date HCD is a ticking time bomb.

Health Care Directives6. Revoked By Accident – Yes, this happens. In fact, it can happen quite easily. Here’s how: if the doctor at the emergency room asks your spouse or child about a HCD and they are unsure, they may sign a new “template” HCD right in the emergency room lobby. Chances are, this “template” HCD may not be the same as the well thought out version you completed with your attorney while you were peaceful and sound of mind.view more updated blog post

A Health Care Directive is an essential part of most people’s estate plans. However, it must be reviewed regularly to ensure that it continues to protect you as you wish. It’s a good idea to talk with an experienced health care lawyer to see what is best for you.

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