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How to Avoid Unintentional Medicare Fraud

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Charges of Medicare fraud can create serious legal headaches including massive fines, loss of healthcare licenses, and even prison time. Even mere allegations of healthcare fraud can significantly damage the professional reputation of your healthcare business. Medicare fraud (or perceived fraud) is not always intentional, however, and it can occur as a result of mere negligence, sloppiness, error, or oversight. What steps can you take to ensure that you, your physicians, and your staff do not unintentionally cross the lines of Medicare fraud? A dedicated Medicare audit and healthcare fraud defense attorney can help.

Keep track of your licenses

Check regularly to ensure that your license and the licenses of your staff are up to date. If your license was expired at the time you performed medical treatment, then you may be charged with fraud, regardless of the fact that you actually performed the procedure billed. Treatment performed between renewals or when a staff member unwittingly let their license expire technically does not count as treatment provided. There have been cases where even a lapse of just a few days led to allegations of Medicare fraud.

Ensure that all medical personnel are appropriately supervised

If you are a physician accountable for supervising other providers, such as physical therapists, it is crucial to know your specific supervisory role. Local rules vary, and a knowledgeable healthcare law attorney can help you identify your specific responsibilities. Under certain circumstances, you may need to be in the same building, be readily available by phone, or even be in the same room. If the other provider is located in a different building or location, then they may not be adequately supervised under the law, which can lead to fraud charges.

Credit back amounts for medications that are not picked up by patients

Establish systems to ensure that medications not picked up by patients are credited. If a patient fails to receive a medication that has been prescribed and already billed for, then the insurance provider is due a refund. Failing to credit back the amount billed can result in a fraud allegation.

Establish clear billing codes and review your billing practices

We have mentioned this before: Keep your billing codes clear and conduct regular audits. Codes should clearly distinguish whether a consultation or procedure was performed by a physician or by another medical professional. Billing clients for a physician consultation when they actually met solo with a nurse practitioner, for example, can be construed as fraud.

Ensure physicians and billing clerks communicate and confirm what services were actually provided

Physicians and billing staff may fall into a routine where each understands that certain routine treatments or services are “always” provided in certain cases. The billing clerk may begin automatically billing for that service whenever a patient of that nature visits. While this can ease the administrative hassle of billing, such practices are a ticking time bomb: If the treatment was not provided for whatever reason in a given case, and the physician and billing staff did not communicate, then the billing clerk may inadvertently bill for a procedure that was not performed. Billing for services not provided is an easy case for fraud.

Steer Clear of Medicare Fraud Allegations with the Help of an Experienced California Healthcare Law Attorney

If you’re a California healthcare provider who needs assistance with matters pertaining to your practice, your licensing, or any other legal issue, get seasoned and effective help by contacting a dedicated Los Angeles healthcare lawyer at the Law Offices of Art Kalantar for a free consultation in Los Angeles or statewide at 310-773-0001.

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