Fraudulent practices can happen anywhere in the patient billing process, and being aware of and able to detect potential issues is a must for any practice. Fraud harms your business in a variety of ways, from loss of income to compliance penalties and even loss of access to some forms of insurance compensation. Understanding some of the different types of fraud and comprehensive compliance training can help you detect potential problems before they can harm your practice.
Identifying and Combating Fraud
Front End Office Fraud: According to the American Academy of Family Physicians, front end office fraud accounts for much of the losses experienced by medical groups. Staffers who have access to deposits can skim off cash, while those who have access to checks and accounts payable can use these assets in a variety of nefarious ways. Even offering some vendors preferential treatment or access and choosing suppliers based on kickbacks and offerings can impact your practice and cause you to lose a substantial amount of money over time. We know that you like and trust your team, but breaches of that trust do happen; fraud detection training can help spot the early signs of trouble and allow you to take action before your practice is irretrievably harmed.
Medical Billing Fraud: From billing for services not actually performed to billing non-covered services so that they are covered, medical billing fraud can begin with the provider. If fraud is suspected, then an investigation can look into dates of service and patient records; a patient should have some documentation of service, even if it is simply the recording of vital statistics or a report of the reason for the visit. If you lack these, you could be suspected of fraud, even if there was no deliberate attempt made.
Medicare Fraud: Fraud reaches a whole new level once government backed entities are involved. Medicare fraud covers not only the types of medical billing issues outlined above, but the sharing of benefit cards between individuals and misuse of benefits. In a 2012 sting operations, authorities brought charges against 91 providers in 7 cities – the providers allegedly brought in over 400 million dollars in fraudulent Medicare billing.
Prescription Fraud: Physicians and other providers who fall victim to a patient’s prescription fraud have a responsibility to report suspected activity and to properly document drug diversion attempts. A single instance of patient fraud may not hurt your practice, but a clear pattern of drug diversion could.
Fraud Compliance and Detection
Becoming aware of the different types of fraud can help you identify the need for an audit or investigation. Fraud training can help identify some of the most common and current scams and prevent someone from harming your business. Left undetected, fraud can damage your practice in a variety of ways – from loss of income and revenue to fines and even criminal charges and bad publicity.
The Core MD partners team combs through all of the latest government fraud regulations and compliance information to ensure that our clients are always secure. With comprehensive knowledge and in-depth investigation capabilities, we have created some custom solutions to the fraud problem and are ready to help your practice stay secure. If you are worried about what might be going on in your own practice or suspect you may have an issue, immediate action can help protect your business and income.
You work hard to make sure your patients receive the best care – and have gone out of your way to build the right team for your practice. We’re here to make sure that your hard work is protected and that your practice is never interrupted or impugned by fraud. Contact us to learn more about your options and how our fraud training can help you protect your practice and your investment and ensure you do not fall victim to medical fraud.