If you are a physician running a small, private practice in New York State, you may not have the resources to outsource a billing firm that may handle your billing procedures on your behalf. You may feel confident that this is a task you and your staff are equipped to handle properly on your own. However, the smallest slip-up may get the Health Maintenance Organization’s (HMO) attention, and not in a great way. In this case, please read on to discover the consequences of being found guilty of medical insurance fraud and how a seasoned New York insurance fraud attorney at Walker Medical Law can help you fend off these damaging accusations.
What are the implications of medical insurance fraud?
Again, when operating a small, private practice, it is understandable that you wish to meet your bottom line and thereby try to bill at the highest amount permitted. But you may overshoot with your calculations and accidentally bill an inappropriately inflated total. Regardless of whether or not you did this accidentally, the HMO may accuse you of committing the criminal act of medical insurance fraud. Other actions that may justify their placing this accusation against you include the following:
- The HMO may accuse you of billing for medical procedures you never actually performed on a patient.
- The HMO may accuse you of misdiagnosing a patient to bill for otherwise unnecessary medical procedures.
- The HMO may accuse you of misrepresenting a medical procedure as a more costly one to obtain higher payment.
- The HMO may accuse you of misrepresenting a medical procedure as a non-covered one to obtain higher payment.
- The HMO may accuse you of waiving a patient’s copay for their unauthorized benefit and overbilling them to compensate for it.
What are the consequences of being found guilty of medical insurance fraud?
In a best-case scenario, the HMO may consider your billing error an accidental, one-off incident. With this, you may hopefully negotiate a settlement agreement to make this whole misunderstanding go away. But usually, the HMO does not act so understanding, and they may proceed forward with full force to report you to the New York State Department of Health’s Office of Professional Medical Conduct (OPMC).
With this, the OPMC may respond by opening a full-fledged investigation against you and your private practice. If they discover a pattern of billing errors and have reason to believe that your actions were intentional, they may impose severe punishments.
For starters, they may order you to repay the total amount you allegedly wrongly charged the HMO. This alone may place your practice into financial ruin, if it is even allowed to still operate. That is, the OPMC may go as far as permanently revoking your New York State medical license if they feel your actions warrant it.
There is no sense waiting any longer if you already know you are to defend yourself in front of the OPMC. So please reach out to one of the competent New York OPMC/OPD misconduct defense attorneys from Walker Medical Law today.
