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3 tips to avoid being investigated for Medicare fraud

Fraudulent practices in the medical industry come with serious consequences. Complying with federal laws is crucial if you accept Medicare patients. Failing to comply can put your medical practice at risk of investigations and jail time.

Even sloppiness and omissions can cause serious problems. Avoid undergoing an investigation for Medicare fraud by following these best practices.

1. Establish and implement robust billing and coding practices

One of the most common forms of Medicare fraud is upcoding, or billing for a service more expensive than what you actually provided. Your billing clerks can even upcode unintentionally, so it is crucial to communicate clearly about the services you provide. Work with your billing staff to double and triple check all Medicare bills. Make sure your staff knows not to change any codes without first consulting you.

2. Renew licenses promptly

Expired licenses can deem any billing fraudulent. If your license is expired, the government does not recognize any services you provide, therefore all billing is fraudulent. Even just a lapse of a few days or weeks can result in investigations. Keep track of when your licenses will expire and renew them as soon as possible.

3. Audit your records regularly

Even after you begin stringent coding and billing practices, errors still happen. Whether your process your billing by hand or electronically, be sure to perform consistent audits to catch any mistakes. Even if any errors were unintentional, you are still liable for overbilling Medicare. If you do not report errors promptly, there could be civil or criminal consequences.

You do not want to face hefty fines or potential jail time due to unintentional fraud. Even if someone on your staff made an error, you will still be held ultimately responsible. Protect yourself by staying on the good side of Medicare billing laws. Following the above tips is key for effective practice management. If you are being investigated for or charged with Medicare fraud, consult a defense attorney.

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