News And Articles RAC Audit Attorney

Claims submitted to Medicare, Medicaid, State Workers Compensation Commissions and other federal healthcare insurers by physicians in the pain management specialty are under increased scrutiny. Pain management physicians have been advised about the significance of submitting compliant medical claims.

An RAC Audit Attorney can articulate the pearls of submitting compliant medical claims. Submitting non-compliant medical claims to Medicare, Medicaid, State Workers Compensation Commissions, or other federal healthcare insurer can lead to substantial legal consequences. Charges that a physician can face include federal healthcare fraud, wire fraud, mail fraud, unlawful distribution of a controlled substance, and making false statements. Each carry individual sentences. A RAC Audit Attorney can provide essential tips on proper documentation to ensure compliance with federal healthcare claims.

Texas pain management physician, Dr. Anthony Valdez, was recently indicted on fraudulent claims submitted to Medicare, Medicaid, Texas Workers Compensation Commission and Tricare. The 99-count indictment alleges that Dr. Valdez fraudulently billed an estimated $41 million. Dr. Valdez has pain management clinics in El Paso and San Antonio. A RAC Audit Attorney is knowledgeable about federal healthcare billing audits and can provide valuable information to the pain management physician.

These alleged charges carry lengthy sentences which would be served in a federal prison. If convicted of the alleged wire fraud charge, Dr. Valdez faces up to 20 years for each count. He faces 10 years for the healthcare fraud charge. Making false statements could result in a 5 year sentence. A RAC Audit Attorney can describe the particular billing practices that would result in each of these charges. Today, pain affects people of all ages and economic status. Naturally, this increases the volume and diversity of medical claims submitted by pain management physicians. The pain management physician inherently prescribes a larger volume of narcotic pain medication because of the particular ailments that he/she treats. Collectively, these factors attract closer scrutiny by federal healthcare billing auditors.

A RAC Audit Attorney can guide the pain management physician through the many intricacies of today’s federal healthcare billing system, and provide insight on how to avoid being subjected to an audit or represent the pain management physician if an audit is conducted.


April 26th, 2011