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Causes of unintentional health care fraud

When it comes to health care fraud, ignorance of the law will not save you. You may think you are safe because you are an honest professional with a qualified billing department. However, errors can lead to investigations, and even if nothing turns up, it can hurt your practice's reputation and finances.

Be aware of these common causes of committing fraud accidentally to avoid legal trouble, high fees and other consequences.

Sloppy business practices

It can be easy to assume there are no flaws in your facility's system because things seem to be running smoothly. However, miscommunication, typos and improper training result in preventable and costly errors. Even if the mistakes are not your direct fault, you are responsible for the billing under your name. Avoid robotic documentation, chart filling and coding in all involved personnel. It may take longer to ensure correct billing, but it can save you from accusations of fraud and abuse.

In addition, sloppy business also means bending the rules for the sake of convenience. For example, if a procedure requires your supervision and you do not meet the requirements of that supervision, the provided service can count as fraud. Other actions include:

  • Practicing during a lapse in licensure
  • Being inefficient or too quick
  • Ordering unnecessary tests

The more these things occur, developing a pattern, the more likely you will face an audit and fraud charges.

Not staying informed

Another common source of unintentional fraud is not staying up-to-date on changes in regulations, technology and related areas. Whether or not you know the law, you will be accountable for following it. It is therefore in your best interest to stay informed to prevent breaking a law. Be careful in giving gifts or incentives to patients, even for charitable purposes. Do not assume you know medical codes; review them often to catch changes. There are courses you can take at conferences or online to ensure current knowledge.

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