What is Billing Fraud and How Can it Affect my Medical Career?

Doctors are tasked with a variety of responsibilities in treating a patient. Once their medical expertise is finished, they must charge their patients with medical bills. In doing so, they are required to charge the correct price and not overcharge their patents. If they do, it is considered billing fraud. Medical professionals who commit these acts can subject themselves to severe consequences, which is why they should retain the services of an experienced medical defense attorney to defend their case. 

What is Billing Fraud?

Patients who receive a medical bill can usually expect a certain price. However, they are sometimes presented with a cost that is higher than expected. This can be noticed by either them or their insurance company. Sometimes, this can simply just be a mistake. While this is true, there are cases that are a medical professional overcharging their patient and committing billing fraud.

When this happens, an insurance company may choose to audit the professional and their office to inquire more. There are two types of billing audits that may take place: a prospective billing audit and a retrospective audit. A prospective audit is conducted by someone in the staff who is assigned this role before the claims are submitted by the patient paying. A retrospective audit occurs after the claim is submitted and the errors are found. Audits can find the professional responsible for taking advantage of a patient. 

What are the Consequences of Billing Fraud?

Doctors who are audited for billing fraud can face certain consequences if they are found guilty of doing so. These are imposed by the Office of Professional Medical Conduct (OPMC) to hold the person responsible for the actions they committed. These have the potential to detrimentally affect a medical career, reputation, and livelihood. While a doctor may not lose their license over the issue, they may be required to pay back large sums of money to avoid charges. These claims can often cause the professional to lose patients as well. 

Contact our Firm

When a medical professional is accused of misconduct, it is essential that they retain strong legal representation. If you require a medical law attorney for your legal matters, call Paul E. Walker, an experienced New York City OPMC & OPD Lawyer. Please contactthe Walker Medical Law firm to set up a free initial consultation.