An allegation of health care fraud may lead to considerable legal implications . Many allegations of health care fraud arise because of billing errors, so recognizing where others have erred before you may help you avoid making similar mistakes yourself.
What are some of the most common medical billing errors that may lead to health care fraud allegations?
Medical upcoding occurs when you or someone else in your office submits codes for procedures or visits that were more serious than those actually given to the patient. Upcoding may also involve billing for a lengthy appointment when a patient only sees you for a few minutes. In especially serious cases, some providers accused of upcoding may no longer take part in Medicare or Medicaid.
2. Code unbundling
Code unbundling is another common billing error you may want to work to prevent in your health care practice. Unbundling codes means you used more than one code to bill for a particular procedure, even though there was a single code you should have used to cover all elements of the procedure.
3. Overuse of modifier 22
You may need to bill using modifier 22 if someone in your practice administered a procedure that required more work or time than expected. When using modifier 22, you need to include appropriate documentation explaining why a service wound up being more complex than anticipated.
Sometimes, medical billing errors occur because of a lack of knowledge, rather than malice or ill intent. However, the repercussions associated with health care fraud remain the same regardless of intention.