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Being a healthcare provider is an incredibly rewarding and important job, where your integrity is put to the test everyday for the wellbeing of your patients. Although you have probably mastered your bedside manner, sometimes providers find that they are committing healthcare fraud behind the scenes. Let’s examine some of the more common ways this can happen and how to protect yourself:

  • Incorrect coding – The occasional coding typo can happen to anyone, but when patients are being billed for procedures that flat out didn’t happen, it’s a fraudulent act. Sometimes it’s a gray area in terms of what code can be used for a specific treatment or visit, but if there’s an option for a more expensive version of something that could be coded at a cheaper rate, frequent misuse of this higher priced code, called upcoding, can raise some red flags. When in doubt, it’s best to bill patients only for services that were received, and to use more expensive codes only when necessary.
  • Providing unneeded services or procedures – This type of healthcare fraud is similar to our first example, yet extends far beyond simply coding. When a provider chooses a more involved and expensive course of treatment instead of exploring other options first, this is certainly considered a fraudulent act. Think about a surgeon who recommends a full shoulder or hip surgery instead of trying physical therapy or a less invasive option first. As a provider, ask yourself how you can help your patients in other ways before jumping straight to the most expensive treatment available.
  • Paying for referrals – In certain facets of the healthcare industry, the competition can be fierce. In order to grow your practice, it’s essential for you to receive referrals from other providers as well as from your established patient base. Anytime you offer money, goods, or services in exchange for a patient referral (kickbacks), you are engaging in fraud.
  • Deviating from medical coverages – Some providers have an exceptional rapport with their patients and have been seeing them for decades. While it’s understandable to want to do your friends a favor, if you regularly waive their copays or deductible payments, you could be committing a fraudulent act. Your patients won’t stop coming to you just because you charge them their applicable fees; they know that any other legitimate provider would do the same thing.

Have you been charged with healthcare fraud or just want to safeguard yourself against the possibility? Contact The Law Offices of Sabrina Puglisi today to discuss your questions.