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Six Unethical Medical Billing Practices

The government recovered over 2 billion dollars in 2018 for fraudulent healthcare reimbursements. This seems like a huge amount, doesn’t it? If the government could recover several billion dollars for a single year of medical fraud, it makes me wonder how much actually occurs every year. LINKS: ____________________________________________ https://etactics.com/blog/unethical-m... ____________________________________________ Upcoding is where someone assigns an inaccurate medical code for a procedure to increase reimbursement. Imagine a situation where a patient got routine medical transportation. But that’s not what the bills say a month later. The bill lists the patient receiving emergency life support transportation. No big deal right? But the emergency life-support transportation is much more expensive. Under coding occurs when the codes used in a medical bill don’t entirely capture all the medical services or procedures performed. In other words, the organization is making a false statement about the services provided and misrepresents what occurred. Under coding also fits within the definition of “abuse,” as defined by CMS as “misusing codes on a claim.” Any attempt to defraud the auditing process violates federal law. So although under coding seems like it isn’t that big of a deal, it can lead to some serious consequences. Duplicate charges, also known as double billing, are where the same bills occur multiple times even though the patient only received the service or treatment once. Of course, humans are prone to make mistakes, especially due to the complicated billing process. But sometimes duplicate charges are intentionally made. This can lead to criminal and civil penalties. Some of these penalties could be thousands of dollars in fines. Phantom charges are when a practice bills for a medical service or procedure that never occurred. It can also happen when a provider submits a claim for unnecessary services. This means that the treatments were only for profit. For example, 22% of prescription medications are unnecessary. So are 25% of medical tests and 11% of procedures. Since all these events were unnecessary, they could be legally considered phantom charges. The Federal Bureau of Investigation defined unbundling as “a practice of submitting bills in a fragmented fashion to maximize the reimbursement for various tests or procedures that are required to be billed together at a reduced cost”. You see, instead of using one code to describe services provided, providers used several different codes to describe different parts of the service. This increases the presumed cost of service, which means a greater reimbursement. Medical equipment fraud is also known as durable medical equipment fraud, or “DME”. This type of fraud occurs when the provider bills for equipment the patient never received. By doing this, the organization can receive money for services never provided. As you can see, billing fraud can occur in many ways. There are a few ways patients can try to avoid such types of fraud. Look at all of the details of the statements you receive from a doctor's office. Examine how many statements exist for the same service. Lastly, question anything in your statements that look off. ► Reach out to Etactics @ https://www.etactics.com​ ►Subscribe: https://rb.gy/pso1fq​ to learn more tips and tricks in healthcare, health IT, and cybersecurity. ►Find us on LinkedIn:   / etactics-inc​   ►Find us on Facebook:   / ​   #PatientCollection #RevenueCycle