Why Federal Billing Carries More Risk

When a physician submits a bill to Medicare or Medicaid, the government relies entirely on that physician's representation that the services were necessary and properly coded. If anything in that claim is false—or even appears to be false—you could face consequences under:

• The False Claims Act (31 U.S.C. §§ 3729–3733)

• The Anti-Kickback Statute (42 U.S.C. § 1320a-7b)

• The Stark Law (42 U.S.C. § 1395nn)

• The Exclusion Statute

• The Civil Monetary Penalties Law

These laws allow the federal government to impose civil penalties, program exclusion, and criminal charges.

Common Billing Mistakes That Trigger Audits

Physicians who bill Medicare, Medicaid, or any other federal healthcare program face more than just paperwork—they face scrutiny under some of the strictest fraud laws in the country.

At Ludwig Law Firm, we help Arkansas healthcare providers stay compliant, respond to audits, and defend their reputations when allegations of fraud arise.

As always - if you have a legal question you want answered in a future blog, submit it via the form on this page. Now, let's dive in!

Call Ludwig Law Firm Today

Call 501-838-4043 or visit ludwiglawfirm.com. We help Arkansas physicians protect their license, their practice, and their peace of mind.

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Disclaimer: The information provided in this blog is for general informational purposes only and is not intended as legal advice. Reading this blog or interacting with Ludwig Law Firm through this content does not create an attorney-client relationship. Every legal case is different, and you should not act or rely on any information in this blog without first consulting with a licensed attorney about your specific situation. For legal guidance tailored to your needs, please contact Ludwig Law Firm directly.

Even if you didn’t intend to defraud the government, you can still face massive liability if you “should have known”about the error.

Accurate Documentation Is Your Best Defense

Every service billed must be:

• Medically necessary

• Clearly documented

• Consistent with CPT codes

• Signed and dated properly

The government can go back years to review old claims, so record-keeping is critical. We recommend that Arkansas physicians retain documentation for at least five years and audit their systems regularly.

HIPAA Compliance Is Also a Legal Concern

Protecting patient data is a legal obligation. HIPAA violations can lead to:

• Civil fines up to $50,000 per violation

• Required reporting to HHS and affected individuals

• Additional scrutiny on billing practices

Invest in encryption, train your staff, and limit access to sensitive data.

When to Call a Federal Defense Lawyer

If you’re facing:

• A Medicare audit

• A qui tam (whistleblower) lawsuit

• A letter from HHS or DOJ

• Or have discovered billing errors internally

You need experienced federal criminal defense counsel immediately.

When the situation is complex, we often work alongside firms like Warden Law Firm to provide full-spectrum support. When a client needs both finesse and firepower, a Ludwig and Warden partnership is the best option.