What seems like a smart billing move could lead to fraud charges

A lot of medical insurance fraud actually involves health care providers and not individual recipients. Both medical professionals and the team that supports them can make mistakes or engage in certain practices that constitute insurance fraud.

Those with professional training about medical billing may know what activities to avoid. However, not everyone who handles billing issues for a medical practice may have that training.

You may have started out as a receptionist and now understand the terminology and billing system well enough to use it accurately. Unfortunately, some of the decisions you make when entering billing information might constitute fraud.

Have you unintentionally violated the law?

There are a lot of rules that apply to the services that health care providers offer the public and how they bill both private and state-run insurance programs. There are many different billing codes, some of which may have overlapping criteria.

You might think that if the doctor used all the same supplies for one procedure as another, slightly more expensive one that billing for the more expensive procedure is a smart decision because it means more income for the office.

It’s also possible that you provided bundled services to a patient. The insurance company will have negotiated a lower payment rate for certain services or treatments offered in conjunction with one another. If you bill for each of them independently to charge more money, you aren’t just maximizing the office’s income. You are unbundling a charge and possibly breaking the law.

The better you understand the rules around insurance and billing practices, the less likely you will be to violate those rules unintentionally. Anyone accused of fraudulent billing practices or similar white-collar offenses could face major consequences. That’s why it’s important to consult an experienced attorney.