Medical professionals who accept Medicare are bound by the rules of the program. Because Medicare is administered by the federal government, there’s no room for error. Many practices use specialists who know the billing practices for Medicare and other health insurance companies.
Billing guidelines for Medicare are very strict, but they’re not unreasonable. Some might be a bit confusing because of the way they’re written, so it’s imperative to know how to handle situations, especially in complex billing circumstances. Two primary things can lead to criminal charges if they occur.
Double billing
Practitioners are only allowed to bill once for a service each time the service is provided. Some practices may have multi-layer billing practices, but it’s imperative to ensure that they don’t overlap for a single service. Medical professionals should always double check that only appropriate billing codes are being used for billing.
Billing for services not provided
Another issue occurs when providers bill Medicare for services they didn’t provide to a specific patient. One problem that might happen is when medical professionals use inclusive billing codes that have charges within them for things the doctor didn’t perform on the patient. In those cases, billing for individual services and supplies may be a safer option.
Medicare fraud is a criminal charge that comes with significant penalties. Professionals who have been charged with this crime should ensure they fully understand the charges against them and the defense strategies they may utilize. Working with someone familiar with this type of charge is beneficial so they can guide the defense.