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Ways to Avoid Healthcare Fraud

Fraud in red letters depicted against white background

Providers face different and complicated healthcare fraud and abuse laws at the local, state, and federal level, and compliance with all of these various regulations can be difficult. Even when healthcare providers have the best of intentions, they may have policies or practices in place that can leave them in hot water with healthcare fraud investigators. The federal government has recently reiterated its commitment to preventing healthcare fraud and abuse, turning to predictive analytics to prevent false medical bills even before providers receive payments in place of the previous pay-and-chase methods. A knowledgeable health care fraud defense attorney can help you input practices and procedures to minimize your exposure to health care fraud investigations and charges, and additionally, your lawyer can defend you should you inadvertently cross the line. Below are several good tips to avoid healthcare fraud.

Audit Your Billing Practices

Billing practices generally are a ripe area for healthcare fraud investigations. Conduct regular audits to make sure you are not overbilling even complicated patients. Make sure your billing codes are applied appropriately. For example, if you hire and supervise nurse practitioners, make sure that solo NP visits are not billed as if a physician was present. If a physician code is improperly used, leading to overbilling, then the NP, the MD, and the practice are at risk for civil and possible criminal charges.

Make Sure Your Licenses Are up to Date

If you are billing after your license is expired or your staff’s license has expired, you may be charged with fraud even though you are actually providing a service. Treatment provided during a gap between renewals or when a staff member fails to renew their license does not count as treatment actually provided; keep your own licenses up to date and continually remind your staff to keep on top of their license renewals, and verify that they are doing so to avoid fraud or conspiracy charges due to what might have been simple oversight.

Supervise Your Employees in Accordance with the Law

If you are located in a different building than certain employees, or in some cases not in the same room or not available by phone, then you may be committing a failure to supervise where it is otherwise required. There are many instances when service providers, such as therapists, require the supervision of licensed physicians, and there are regulations that specifically and strictly define what “supervision” entails. If you are not meeting and documenting this supervision, you may be opening your practice up to fraud charges.

Ensure You Credit Back Medication That Was Never Received by the Patient

If a prescribed medication was not actually dispensed or picked up, you must credit back that medication. Keep a system in place to flag medications that were prescribed and billed for but which the patient never actually received.

Limit and Monitor Gifts and Other Quid-Pro-Quo

Doctors and NPs often receive gifts or increased pay for seeing more patients. You should ensure that gifts are minimal, rare, and generally limited to under $50; even lunches with an in-service should be done infrequently. If you are a practitioner, avoid contracts with entities that are based on how many patients you bring in, and avoid unusually frequent gifts, even if they seem small.

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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