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Is Your Practice Fraudulently Billing?


Most of our clients would obviously answer ‘no’, however, some providers are submitting bills incorrectly and could be subjecting themselves to hefty fines.

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Recently, a Florida Cardiology group and 10 of its physicians agreed to pay $2 million to settle False Claims Act allegations.

According to the settlement, the group submitted inflated claims to Medicare and Medicaid and billed for services while they were outside of the United States.

Whistleblowers were involved in bringing this scheme to light.

While your healthcare practice might not be as brazen in violations, this serves as a good reminder to perform regular internal audits and review your billing.

Many of our practices think that their billing is perfect, however, there are often issues when we perform an audit of their billing.

Obviously, it is essential to make sure that you are not upcoding. It is also important to make sure you are not underbilling or misrepresenting services.

It is always important to remember, if it’s not in the chart, it didn’t happen – as far as billing is concerned.

Make sure that your policies and procedures are up to date and your compliance plan is active.

Your employees need to be trained regularly and know what to do to report their concerns internally.

If employees do not feel that their concerns are taken seriously, this is when they become whistleblowers.

It is important to routinely reassess your Electronic Medical Record template, to make sure that it is not causing any issues with your patient records.

We help our clients to update their compliance plan, audit and mitigate potential issues and train staff to make sure that they are not in violation of any federal law.

If you have questions or need help with your healthcare practice, employee training, or security, contact Rickard & Associates today.

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