As a medical professional, you may not be blind to how expensive your offered medical treatments are. You may feel guilt when you witness your patient torn between the fact that they require these medical treatments to recover their physical health yet opting for them would have them incur overwhelming financial debt. So, since it is in your career’s nature to try and help your patients as much as possible, you may give them a “break” with their final bill. Well, for this, please continue reading to learn whether you can get in trouble for underbilling your patient and how an experienced New York billing fraud attorney at Walker Medical Law can guide you on the right thing to do.
Will I get in trouble for intentionally underbilling my patient?
Similar to overbilling, intentionally underbilling your patient for provided services may be considered a form of fraud and abuse. This is because, with this, you may be purposefully misrepresenting the complexity of your administered medical procedure to bill less than what you actually performed. Or, you may be deliberately using lower-level current procedural terminology (CPT) codes when submitting claims to insurance providers.
Overall, if you get into the habit of underbilling, you may make your medical practice more vulnerable to audits and reviews by the Healthcare Maintenance Organization (HMO) and the government. If, after an audit and review, these entities conclude that you have created a compliance liability, they may order you to pay what they estimated you to have underbilled. Obviously, this may result in a great monetary loss for you, not to mention a blow to your reputation in the medical community and other potential consequences.
What are ethical ways to help my patient with their bills?
Even if you underbilled intentionally, we understand you simply may have wanted to help your patient afford their necessary medical treatments. Well, there are legal, more ethical ways to accomplish this same thing. Below are some tips for this:
- Be transparent about the potential cost of their medical treatment, what is covered by insurance, what they are expected to pay out-of-pocket, etc., before they consent to it.
- Educate your patient on their potential eligibility for Medicare, Medicaid, or other government assistance programs that may relieve some of their medical treatment costs.
- Have your medical office offer the option of a payment plan, in which your patient may pay their medical bills in interest-free installments over time.
- Have your medical office offer the option of a sliding fee scale, in which your patient may negotiate a reduced rate given their ability to pay.
To ensure you do not go through this critical yet complex process by yourself, please reach out to a skilled OPMC/OPD misconduct defense lawyer. Our team at Walker Medical Law is more than happy to serve you.