How costly is Medical Billing Mistakes and Fraud?

Even though working from the comfort of home as a medical billing professional may seem like the near-perfect career, offering benefits and advantages that within a doctor’s office or healthcare center are unavailable, the ramifications of possible mistakes can be very costly.

An example of how things can go wrong can be shown by MSO Washington, Inc. MSO is a medical practice management and billing service company that had to agree a settlement against claims of healthcare fraud, to the value of $565,000. The Dept. of Justice alleges that the company made claims to Medicare and Medicaid for settlement which failed to include the proper records and claims for procedures that were deemed medically unnecessary. The Department found that in some cases the procedures claimed for were never completed, or they were executed but charged for at rates above the industry standard.

It seems as though the healthcare providers were allegedly not aware of the questionable billing practices, and consequently, they were not a part of the investigation. The system that was under investigation was a home visitation program, in which doctors and medical professionals visited homes to inspect the residence itself.

As a professional and highly-trained medical professional, one would be able to detect anomalies and point out possible fraudulent activities. There is great value placed on such individuals, and as a result, insurance companies and government-based agencies will depend heavily on that person’s skills and training, as well as their moral character. After all, one would have medical documentation of many patients at hand.

Throughout the education and billing services classes, one is expected to learn every part of the coding systems that are used and relate to procedures, medical products and the services that their respective companies provide. Important aspects that medical offices and hospitals seek out when looking for specialists include a concern and prioritization of getting their job done; correctly and efficiently.

Where claims are concerned, most companies/offices will seek out a fair reimbursement for their services. Companies can lose vast sums of money through malpractice, accidental or intentional.

The owner of MSO Washington Inc. did not admit liability, so it can be deemed that the fraud was accidental and not intentional. This only highlights the importance of personnel who can account for their work and ensure that there are no errors. High-quality personnel are able to seek out the correct compensation while preserving a fraud-free status.


Daina said...

If you’re not using HCPCS codes correctly, get your pen ready for major paybacks. With HCPCS codes making the top error reporting lists, be prepared for auditors to hone in on your equipment and supply coding. Penalties for double billing on supply and drug codes can run into the hundreds of thousands.

Bethany said...

Duplicate charges and clerical errors are common which is a sad thing. However, fraud can easily be detected and avoided.


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