The Health Maintenance Organization (HMO) and the government routinely audit medical billing records to find where physicians may have billed their patients improperly. At the same time, they may do this to attempt to recover money paid to physicians. They may do this may only auditing a small sample of a physician’s billing, without any regard to how inconsistent or inaccurate this Because of these ruthless tactics, you must be very conscious in accurately billing your patients. Otherwise, you may unnecessarily get into trouble. Read on to discover the most common examples of medical billing fraud and how a seasoned New York billing fraud attorney at Walker Medical Law can help if you are ever accused of such.
What are the most common examples of medical billing fraud?
The New York State Department of Health’s website defines fraud as conduct intended to deceive. Therefore, medical billing fraud may be seen as improper billing to deceive all involved parties intentionally. The three most common ways this may occur are through upcoding, unbundling, and billing for services that were not provided.
Firstly, upcoding may happen if a physician sends a bill to Medicare or another payor for a more expensive service than the one actually performed. For example, a physician may exaggerate the length of time or the amount of staff it took to perform a surgical procedure.
Secondly, unbundling may be when a physician bills several different procedure codes for a group of procedures, even though the group can and should be billed under a single code. As an example, a physician may bill for each individual blood test they ordered for their patient instead of billing for the panel of blood tests conducted altogether.
Lastly, billing for medical services that were never provided or medical equipment that was never delivered to a patient may constitute a false claim. For instance, a physician may claim that a patient underwent an X-ray scan and an MRI scan for their medical issue when in reality they only ordered them to get an X-ray.
What happens if I am accused of billing fraud?
It is not a good thing for the HMO or the government to accuse you of any of the aforementioned forms of medical billing fraud. If they do, they may send you a demand letter. This letter may read something along the lines of, “We have audited 30 charts and found that you over-billed us by 15 percent, that is, you billed us $10,000 when you should have billed us $8,500. Further, over the last five years you have billed us $500,000. By applying the 15 percent figure we hereby demand that you return to us a total of $75,000.”
While you may have had a one-off incident of accidentally over-billing for your medical services, this demand letter may be an inaccurate representation of what you owe back. In conclusion, at Walker Medical Law, we share the same goal as you, which is likely to be found not guilty of the accusations placed against you. So please do not hesitate to work with a competent New York billing fraud attorney from our firm today.
