Although testing is appropriate in many cases, some providers submit patients to testing, even if the results will not determine if the patient has a particular disease or if there is no reasonable purpose to perform the test. X-rays, for example, may be performed to examine possible medical conditions or injuries. However, X-rays performed on every patient or that are performed unnecessarily can be considered fraudulent.
If a provider performed tests on a patient without intending to commit fraud, then sufficient documentation should be provided that shows why the tests were performed, as the provider could be audited. If there is no documentation to validate performing the test, then the provider could face charges of healthcare fraud.
Healthcare Billing Fraud: Miscoding
Some medical providers may use an incorrect code or coding procedure and receive more payment for a service than otherwise provided.
Common healthcare fraud coding issues include:
- Upcoding – Involves using a service code that results in higher payment for the provider. For example, a patient may see a doctor for a short, 10 minute visit, but the provider may bill for a longer, more complex visit at a higher rate.
- Unbundling – Taking services that are typically bundled together and billing them separately using individual codes in order to receive a higher payment.
- Double billing – Billing for the same service twice, when was performed only once.
- Improper equipment billing – Billing for more expensive or complex equipment when inexpensive equipment was provided, or if the equipment was never used or required.
However, these practices are not always intentional, in which case a Fort Lauderdale insurance fraud lawyer can help. For example, a billing department may make a simple mistake or mix up two numbers in a code, which can mean the difference between an inexpensive service and one that triggers a red flag with authorities. Proper communication and thorough internal claim reviews are crucial in a medical setting.
Consult a Fort Lauderdale Insurance Fraud Lawyer
Doctors and their staff are human and prone to make mistakes. These mistakes shouldn’t cost an otherwise well-respected doctor his or her medical license, or result in fines, jail time or another penalties for healthcare fraud. Robert Malove is a Fort Lauderdale insurance fraud lawyer who understands the frustration a doctor feels when he or she is wrongfully accused of healthcare fraud. Those accused of healthcare billing fraud can contact Robert Malove at 954-861-0384 to set up a consultation.