Four Tips for Submitting a Medical Fraud Lawsuit

Medicare Fraud Lawyer

Medicare Fraud Lawyer

Medical fraud is committed when a dishonest provider or consumer intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits payable.

Some examples of medical fraud are:

  • billing for services not actually performed;
  • falsifying a patient’s diagnosis to justify tests, surgeries or other procedures that aren’t medically necessary;
  • misrepresenting procedures performed to obtain payment for non-covered services, such as cosmetic surgery;
  • upcoding – billing for a more costly service than the one actually performed;
  • unbundling – billing each stage of a procedure as if it were a separate procedure;
  • accepting kickbacks for patient referrals;
  • waiving patient co-pays or deductibles and over-billing the insurance carrier or benefit plan;
  • billing a patient more than the co-pay amount for services that were prepaid or paid in full by the benefit plan under the terms of a managed care contract.

Varying state regulations are just one example of the procedural confusion surrounding how to file a medical malpractice suit explains a medicare fraud lawyer from a law firm such as Morales Law Firm today. If you are in the position to bring a case against your health care provider, here are four tips for a smooth process.

1. Talk To Your Medical Professionals and Insurers 

Before submitting a case to the court, some states require that you contact the health care providers who you believe performed malpractice. Legally obligated or not, notifying your providers and insurers in advance may lead you to a settlement before filing a lawsuit. 

Oftentimes medical professionals will perform appropriate services, sometimes at no cost to the patient, to remedy the situation before proceeding with a lawsuit. 

2. Consider a Certificate of Merit

To save time and money for both the plaintiff and defendant, many states have laws that require a certificate of merit, or some form of proof that medical malpractice did, in fact, occur. The certificate requires another physician to first review your medical records and then state that the defendants were most likely negligent in treating the plaintiff. 

3. Speak With a Medical Malpractice Attorney 

A medical malpractice attorney will understand what you must obtain or complete before filing a lawsuit. Like most rules surrounding medical malpractice suits, these prerequisites vary state by state. One specific detail your attorney can help you understand is the statute of limitations deadline where you are filing. These statutes require that you submit your claim during a specific time period. 

4. Acquire Your Medical Records

As soon as you think you may have a medical malpractice case, request a copy of your medical records. Moving forward, you will be required to grant your attorneys and the defendants’ attorneys access to your records as well. 

The sooner you have copies, the faster your attorneys can analyze the case and find other medical professionals who may act as medical expert witnesses. On the other hand, your attorneys may review your records and conclude that filing a lawsuit is not in your best interest. 

If you believe you or a loved one has suffered from medical fraud, contact a local Medicare fraud lawyer.