How Can Healthcare Providers Protect Themselves from Fraud Allegations?
Healthcare fraud may result in as much as $300 billion in losses to the healthcare industry each year. While fraudulent claims only account for a small portion of healthcare expenditures, they do place a financial drain on an already overburdened system. The prevalence of this issue places patients’ lives at risk while costing hardworking citizens billions of wasted tax dollars. Given the increase in cases with each passing year, the government is cracking down on the issue like never before.
While most providers adhere to appropriate billing practices, a minority of those who fail to uphold their ethical obligations result in a national cause for concern. In this blog, the Greenville insurance fraud defense lawyers at Ryan Beasley Law would like to provide our suggestions on what steps healthcare providers should take to protect themselves from fraud allegations.
What is Healthcare Fraud?
In simple terms, healthcare fraud is the act of deceiving the healthcare system to earn illegal benefits. This may involve providing misleading, incomplete, or inaccurate information on a claim submission. Healthcare fraud can be committed by either providers or recipients. Examples of provider fraud involve billing for services not provided, billing for unnecessary medical services, or offering another physician or supplier a financial incentive in exchange for patient referrals (known as a kickback). At best, healthcare fraud robs the American people of billions of dollars in tax money each year. At worst, it places patients’ lives in danger.
Healthcare fraud has been a growing concern in our nation for years, but fraudulent acts related to COVID-19 may be among the most blatant. Examples include billing for COVID-19 tests that were never administered, charging patients for the coronavirus vaccine (which was free), and false billings to access money from the Provider Relief Fund.
Safeguarding Yourself Against Healthcare Fraud Allegations
The first step in protecting yourself against healthcare fraud is to ensure that you are complying with state and federal regulations. The federal government suggests that the healthcare community abide by the General Compliance Program Guidance (GCPG), which encourages organizations to take the following actions:
- Conduct internal monitoring and auditing.
- Implement written compliance and practice standards.
- Identify a compliance officer or contact.
- Conduct appropriate training and education.
- Respond appropriately to problematic claims or issues and develop a remediation plan.
- Maintain open lines of communication with employees.
- Enforce disciplinary standards through well-publicized guidelines.
As discussed, kickbacks occur when a provider receives a financial benefit in exchange for patient referrals. A kickback rarely benefits the patient and in many cases is medically unnecessary. It is crucial that a healthcare organization enforce written compliance standards so that potential problems, such as kickbacks, are avoided.
In this vein, problematic arrangements should be identified to prevent a healthcare provider from violating the Federal anti-kickback statute. The GCPG lists key questions in identifying if a potential conflict exists, including the relationship between the parties, the nature of the services or goods provided, and whether the arrangement could affect your clinical judgement. While the list is not exhaustive, it is a good starting point to judge if you are in line with federal regulations.
While you may take all preventive measures to avoid legal repercussions, the complexities of the healthcare system can make it difficult to avoid any suspicion of a fraudulent claim. The conduct of healthcare professionals is being examined more than ever before, with insurance companies and government agencies using their ample resources to prosecute offenders. If you have been accused of healthcare fraud, do not hesitate to contact the legal team at Ryan Beasley Law. The government’s resources are no match for our detail-oriented approach and fresh approach to building your defense.
Greenville Insurance Fraud Defense Lawyers Offering Tenacious Representation
Given the state of doubt hanging over healthcare professionals, being a physician comes with inherent risks. If you have been accused of healthcare fraud, the Greenville insurance fraud attorneys at Ryan Beasley Law are prepared to come to your defense. Since 2001, our legal team has honed its skills in crafting an intricate defense, mitigating the consequences faced by our clients. To arrange your consultation, contact us online or give us a call at (864) 756-4204 today.