Health care fraud is a growing concern for many medical and health care providers in Texas. Some providers seek to profit off unlawful activities to increase their profits. However, many health care providers are honest and under heavy scrutiny and sanctions because of the wrongful actions of others. Some potential causes of health care fraud are the result of mistakes in the billing process. Many of those errors are avoidable with the right processes and checks and balances in place.
Take some time to learn about common medical billing mistakes that can occur so you can take measures to avoid them and protect your practice from fraud.
Although many health care facilities use codes and electronic billing software to help them manage their billing processes, duplicate billing is still a big problem. With so many medical billers managing heavy caseloads, identifying all cases of duplication is a challenge. Ways that medical care providers can avoid this problem include reducing the number of cases their billers are required to complete, incorporating multi-step review processes and increasing employee accountability.
Billing for services not rendered
Some providers intentionally and unintentionally bill for services their patients never received. Keeping track of services that patients receive can be a challenge, especially for small health care facilities that do not have the same resources as many larger facilities. Requiring medical care providers to document every aspect of their patients' visits and double-checking patient files to ensure all billing documentation matches up can significantly reduce the number of billing for non-rendered services claims.
Wrong dates of service
Some medical providers try to maximize their profits by submitting claims that have the wrong dates of service. They may take services that their patients receive on one date and split them so it looks as if their patients received them on two or more separate days. Not only is this practice very misleading, but it can result in providers receiving more payment than they are lawfully entitled too. This problem can be avoided by double-checking each claim to ensure that the dates of service match the dates of service in patient records.
The above errors and many others that are not listed are common reasons why suspicions of health care fraud can occur. It is necessary for medical and health care providers to become more thorough in their billing practices to increase accuracy and avoid the consequences that fraud allegations and investigations bring.