Tips on How to Protect Your Company from Health Care Fraud Claims

Owning and operating a medical clinic can be extremely exhausting, with lots of room for error. One of the biggest risks that clinicians face on a daily basis is healthcare fraud and abuse. This type of fraud can be linked to mistakes or negligence, but most often ends in disaster. Luckily, there are ways to prevent these errors from occurring and with a bit of employee training and practice, you will be able to run your clinic worry-free. Below, you will discover several ways to protect your reputation and business from allegations of Medicare fraud.

Claim Codes

Instead of relying on unskilled workers to submit claims to insurance companies, Medicare and Medicaid, you should hire a certified medical billing coder. This professional has undergone educational courses and training for both medical billing and coding processes. The professional is familiar with utilizing ICD 9, CPT and HCPCS codes, so they will know exactly how to input them into the computer system.

Relying on unskilled workers will put you at a high risk of misusing the codes on a claim. While you may get by with it for a short time, it will finally catch up with you. If the patient or insurer discovers the discrepancy, they may decide to bring it to your attention first and then report it to the Fraud, Waste and Abuse Department. Once a fraud claim is filed against your business, you will be forced to seek representation, because you do not want your name dragged through the court system.

Administering In-Office Treatments

Hiring medical professional to preform treatments on site can be extremely expensive. This is why many physicians will turn to unlicensed, uncertified and unskilled workers to perform the treatments. This is a huge mistake, even though the individual is trained to perform the treatments to a tee. If the unqualified worker is discovered, you very could become a suspect of fraud and abuse. A patient or another employee may just report this finding to the Fraud, Waste and Abuse Department.

In the long run, you would have saved yourself the grief of dealing with a fraudulent claim and hiring a health care fraud attorney.

Patient Deductibles And Co-Pays

A huge mistake that physicians make is waiving co-pays and deductibles for patients. Many doctors feel compelled to waive these fees for friends, family members and other close acquaintances. This is just one example of health care fraud and happens more often than one would think. Medical professional are required by law to charge all patients co-pays and deductibles, based on their health care insurance.

Patient Referrals

All medical professionals appreciate patient referrals from hospitals and other health care providers. In fact, some physicians will go so far as offer these medical professionals an incentive or kickback for referring patients to their office. This is a fraudulent practice that could lead to a full-blown FBI investigation. This agency is responsible for exposing and investigating all claims of health care fraud and abuse.

While these kickbacks do look enticing, you should never partake in this type of practice. Always be fair and partial, when referring patients to specialists.

Costs Of Medical Supplies

Yes, medical supplies and equipment can be extremely expensive. Medical professionals are reimbursed for these items, along with medical services, but it is up to the doctor to bill the insurer. One of the most common health care fraud claims involves billing for unnecessary or excessive medical supplies and services. Most insurers, Medicaid and Medicare are aware of the costs of these items, so they will be able to easily detect an over-exaggerated bill. An extremely high bill will be a major warning sign so do not think that it will pass the billing department.

Published by Kidal Delonix (1198 Posts)

Kidal Delonix is a contributor to Mr. Hoffman's blog. The views and opinions are entirely his/her own and may not reflect Mr Hoffman's views.