Health care fraud is a major issue that continues to contribute to the financial burden of patients everywhere. Not only does it exploit patients when they are weak and at their most vulnerable, it also causes financial challenges for all, especially people who receive Medicaid and Medicare benefits. One issue that contributes to the growing number of health care fraud investigations and criminal charges is poor billing practices.
Not all medical practices structure their billing policies so they comply with the law. Sometimes, the oversight is intentional, and other times, it is not. To prevent unnecessary scrutiny by CMS and ensure compliance, here is a good reason to regularly audit all medical billing practices.
Shockingly, medical supply giants like Walgreens are not immune to allegations of health care fraud. As a result of two recent federal qui tam whistleblower lawsuits, Walgreens must pay the State of New York $14.5 million out of a $269 million settlement. Part of the verdict is the result of the medical supply entity knowingly engaging in erroneous billing practices. At the time of the investigation, the company had allegedly falsified reimbursement statements for Medicare and Medicaid due to its electronic management system and prescription savings program.
Fraudulent billing can occur in several ways, including:
- Misclassifying patient procedures
- Falsifying diagnoses
- Billing for bundled services separately
- Billing insurer for patient copays and deductibles
- Charging for non-rendered services and medical equipment
- Padding claims with bogus charges
Two examples of fraud, in this case, involve Walgreens knowingly billing for insulin and medical equipment patients did not receive and misleading Medicaid about its prices to receive overpayments.
Health care fraud situations like this are preventable through regular audits. Mistakes can happen, but the longer they remain unreported and managed, the more it could cost to resolve it once charges are involved. If discrepancies are discovered, legal advice may be necessary.