When people talk about health care fraud, they often think about individuals seeking care that they don’t have a right to receive. Someone might. for example, try to gain access to government health insurance programs or even steal another person’s identity to avoid responsibility for hospital stays.
However, according to the FBI, the most expensive forms of health care fraud are the result of healthcare providers and their support staff doing illegal things. Obviously, you know that you can’t bill for an appointment that a patient didn’t attend, but what you may not realize is that a few other common billing practices could also put you at risk of white-collar criminal charges.
Unbundling and upgrading are two of the biggest issues
Especially when you seek payment from a federal insurance program, the rules for making a claim are very strict. You can only bill for the exact services rendered, and you have to comply with the contract that you have with the insurance provider.
Two of the more common forms of insurance fraud that may seem minor to you might include unbundling charges and upgrading charges. Unbundling occurs when you charge separately for multiple services typically billed together at a reduced rate. Upgrading charges would mean inputting a different billing code to ask for more money for a slightly more expensive procedure or service than the one provided.
Although you may think of these as minor issues, they could lead to federal investigation and prosecution. Over the course of many years of work and caring for hundreds of patients, those little changes in billing could add up to tens of thousands of dollars. Knowing what to watch for when reviewing your medical practice’s billing policies can help you avoid unintentionally committing a white-collar crime.