Medical Billing Fraud

Medical bill fraud has victims and can occur in a variety of ways.

Doctor with patient

1. Code Misrepresentation

The physician performs service A, but submits a bill for more expensive procedure B, or A and B.

2. Fraudulent Observation or Cloning

More elaborately, a false set of observations or other materials is provided, sometimes from another patient.  Indeed, a computer may even compile a set of false information for electronic filing.

“Electronic health records (EHRs) replace traditional paper medical records with
computerized recordkeeping to document and store patient health information. Experts in  health information technology caution that EHR technology can make it easier to commit fraud. For example, certain EHR technology features may be used to mask true
authorship of the medical record and distort information to inflate health care claims.
The transition from paper records to EHRs may present new vulnerabilities and require the Centers for Medicare & Medicaid Services (CMS) and its contractors to adjust their
techniques for identifying improper payments and investigating fraud. ”
https://oig.hhs.gov/oei/reports/oei-01-11-00571.pdf

According to the government report, frauds may be more difficult to detect with electronic billing,

“Electronic health records (EHRs) replace traditional paper medical records with
computerized recordkeeping to document and store patient health information. Experts in health information technology caution that EHR technology can make it easier to commit fraud. For example, certain EHR technology features may be used to mask true
authorship of the medical record and distort information to inflate health care claims.
The transition from paper records to EHRs may present new vulnerabilities and require
the Centers for Medicare & Medicaid Services (CMS) and its contractors to adjust their
techniques for identifying improper payments and investigating fraud. ”

 

CALL (973) 598-1980 FOR A FREE CONSULTATION ON YOUR MEDICAL BILLING FRAUD CLAIM .  CONFIDENTIAL INQUIRIES WELCOME

 

Man in home office on telephone using computer smiling

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