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How can I avoid health care billing fraud mistakes?

What seems a minor change in how doctors and other health care providers document patient charges in Florida could result in charges of healthcare fraud. Although you may think that you are correctly documenting patients, even a small change can result in serious charges.

Categories of health care fraud

Even if you provide impeccable patient care and have a stellar reputation among your peers, you can still have accusations of health care fraud. The most common form of fraud involves billing for services not provided. Nevertheless, other major types of medical fraud are also common, including:

Violations of statutes involving controlled substances

Misrepresenting the nature of provided services

False cost reports

Misrepresenting remedies or credentials

Illegal remunerations

Auto accident scams

Providing unnecessary or substandard services

Fraud often includes misrepresenting a diagnosis to receive payment, actions involving kickbacks, falsifying treatment plans and records to receive compensation, unbundling or exploding charges and upcoding.

If the government finds you in violation, you could become subject to conviction by state and federal statutes. Medicare and Medicaid law considers misrepresentation of services rendered a felony, subjecting you to fines and imprisonment. Computerized billing makes it easy for the government to catch health care fraud.

What can I do to protect myself?

The best course of action is to implement a compliance program in your practice. The U.S. government expects you to know and understand proper billing procedures and regulations. Using a defense that you were unfamiliar with a particular billing system almost never works.

A comprehensive compliance program that includes educating billing personnel and others in your practice will go a long way toward ensuring that your office runs properly while helping to eliminate fraud and minimizing legal fees and penalties for violations. Compliance participation will also help minimize government audits.