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Three things medical providers should know to prevent Medicare overpayment investigations

The government will come after those it believes wrongly received payment or overpayment from Medicare, Medicaid, or other federal programs — often aggressively. It is best to avoid such an investigation if possible. Physicians and those who run medical practices can mitigate the risk of an overpayment investigation or allegations of healthcare fraud with the following tips.

#1: Keep organized records

Allegations of overpayment are often connected to concerns of duplicate submissions, upcoding, or provision of services that are not medically necessary. The best defense to these allegations is the use of an organized record keeping system. This means that the accused should likely have evidence to contradict such claims.

Having a record keeping system and encouraging treating physicians to take the time to properly document care can not only reduce the risk of allegations of wrongdoing but also provide the evidence needed to rebut any of these claims.

#2: Review billing practices

It is important to make sure the billing department is following all applicable regulations and properly filing claims. Put a system in place that assigns all codes appropriately. A failure to do so can catch the eye of authorities and result in a closer look potentially triggering a full-scale investigation.

#3: Know the expectations

The government does not just expect medical practitioners to file appropriate claims, it also expects you to identify, report, and return overpayments through “reasonable diligence.” A failure to do so can result in additional delays and penalties.

Attorney John Rivas is responsible for this communication