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October 30, 2015

States to Crack Down on Medicare Fraud

October 30, 2015

Medical Billing Services Company

Earlier this year, the Office of the Inspector General of the Department of Health and Human Services vowed to crack down on health care fraud.

In the words of the Inspector General:

“Health care fraud drives up healthcare costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries.”

As a result of this new initiative, there has been a nationwide sweep of Medicare fraud, including false billings (one of the most widespread instances of healthcare fraud). Already, 243 individuals – including 46 medical professionals – have been penalized for crimes totaling roughly $712 million. This doesn’t include the providers who have been suspended by the Centers for Medicare & Medicaid Services.

The implication is clear: a crackdown is occurring, and every provider needs to redouble his or her efforts to make sure there is no chance that they are committing fraud, either intentionally or unintentionally.

Avoiding the Impression of Fraud

There are providers throughout the nation who are intentionally gaming the system. Unfortunately, there are also providers who are doing things when it comes to billings that are unintentionally running afoul of the Medicare fraud sweep.

For example, one common practice is inappropriate billing. It’s not uncommon to have a service administered by a NP or PA billed under a physician’s NPI. However, there are criteria that need to be met for this to be legitimate. If you’re not meeting those criteria, that could qualify as fraudulent billing. If the services aren’t ‘incident to’ the services of a physician, they shouldn’t be billed under the physician’s NPI.

Also, waiving copays and deductibles could potentially qualify as fraud based on your state’s regulations. This is a common practice, but there are providers who do not realize that their state doesn’t allow that particular practice, which could land a clinic in trouble.

Additionally, some providers, in an attempt to help the patient, exaggerate conditions and symptoms or document elements of a diagnosis that aren’t legitimate. This is most often an attempt to help the patient qualify for coverage for the care they need. Of course, while this may be altruistic, it’s also illegal and could subject a practice to charges of fraud.

Working with a Medical Billing Company

By far, the best way to avoid all impressions of impropriety is to insulate a provider and a clinic from potential charges by placing billing in the hands of a medical billing company.

A medical billing company can handle all aspects of the billing process and help avoid complications and potential charges. The company’s superior training and expertise can make sure that no impropriety is inferred, and that unintentional problems do not emerge.

Contact MBM for a medical billing company that can help you avoid accusations of fraud and keep your office protected from the powers that be during this year’s fraud crackdown.

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