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What is Upcoding Medicaid Fraud?

Our experienced healthcare fraud defense attorneys answer your questions

Specific codes exist for every medical procedure covered by Medicaid, the government-funded health care program for low-income residents and other people, including pregnant women and handicapped people. Each medical test has its own code. The same is true for every surgical procedure covered by Medicaid.

Medicaid reimburses health care providers based on the codes provided for each service. Most medical professionals provide the correct code. Sometimes, mistakes happen. Instead, a different code is entered, resulting in Medicaid paying more for the medical procedure. This practice is known as upcoding.

Upcoding is considered healthcare fraud and carries very severe penalties, especially in cases of Medicaid and Medicare fraud. That’s why it’s critical that you have an experienced Medicaid fraud defense attorney on your side, fighting for your rights. Our lawyers at Brewer & Pritchard, P.C. can help you every step of the way. We know the law, understand how the legal system works and will work tirelessly to build the strongest possible case on your behalf.

What are examples of upcoding Medicaid fraud?

When it comes to upcoding and Medicaid fraud, there are many common examples of Medicaid fraud, including:

  • Entering the wrong Medicaid code for a medical procedure
  • Entering the wrong Medicaid code for a medical test
  • Entering the wrong Medicaid code for a surgical procedure

You might think you don’t need a lawyer to handle these legal issues, especially if you or another employee at your medical practice accidently enters the wrong Medicaid code when submitting reimbursement forms to Medicaid.

Our experienced defense attorneys know how to handle complex legal cases. This is especially true if you as a doctor didn’t do anything wrong and performed the correct medical procedure and entered the correct code. Sometimes, proving you did nothing wrong takes a lot of work. We are prepared to do the work that needs to be done to set the record straight.

Take a stand for your rights. Contact our law firm.

Don’t underestimate the complexity of your upcoding Medicaid fraud case. Contact us and make an appointment with an attorney at our law firm. We know the law and know how to find the facts that matter. Schedule your case evaluation today. Our experienced, Medicaid fraud defense attorneys handle cases throughout Texas and across the country.

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