Health care professionals and members of their support staff can face allegations of health care fraud for seemingly minor mistakes. Particularly when organizations accept government insurance coverage such as Medicare or Medicaid, billing practices can potentially lead to federal criminal charges.
There are some types of health care fraud that are obvious and therefore easy to avoid. It is always inappropriate for doctors to perform unnecessary procedures just to bill for them. It is also inappropriate to unbundle discounted services to bill for them separately or to upcode by charging for a more expensive service than the one the physician provided.
Most health care practices want to optimize the revenue generated, which involves maintaining a full patient schedule. When patients do not arrive for their scheduled appointments, they may be accountable for a no-show fee. Trying to obtain compensation for those fees from federal insurance programs or private businesses could lead to fraud allegations.
No-show fees are a patient responsibility
Health care costs typically fall into one of two categories. Some expenses are eligible for coverage through insurance. There are also certain costs that become patient responsibilities. Patients may have to pay a copay at every appointment or may need to cover a percentage of their costs if their policy includes coinsurance. They may also have to meet a deductible before their policy pays for their care.
No-show fees are another form of patient responsibility. The individual patient is the only party that the medical practice can hold accountable for their failure to show up for an appointment. Attempting to bill for an appointment that the patient did not attend or a procedure that they did not undergo can constitute fraud.
Even when the patient asks for the practice to bill their insurance because they cannot afford the no-show fee out of pocket, the business could be at risk for complying with those instructions. Falsifying information about patient appointments can lead to accusations of health care fraud. Billing professionals and coding specialists are among those who could face criminal charges in a scenario involving insurance billing related to no-show fees.
Sometimes, what looks like health care fraud is actually inadequate communication or documentation. Reviewing a situation – with the guidance of a skilled legal team – that has led to criminal charges can help health care providers and their support staff fight allegations of fraudulent billing activity.
