Don’t Be the Next Victim of Billing Fraud and Abuse

Michael R. Marks, MD, MBA

Don’t Be the Next Victim of Billing Fraud and Abuse
AAOS Now- October 2018
By: Michael R. Marks, MD, MBA

Every physician has scenarios they seek to avoid: bad nights on call, less than optimal outcomes, and the fear of malpractice suits. What many don’t think about are coding mistakes that could result in federal investigators knocking on the office door. Audits may uncover coding errors, resulting in stiff fines and even jail time.

Examples of Medicare fraud include:

  • knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to obtain a federal healthcare payment for which no entitlement would otherwise exist
  • knowingly soliciting, receiving, offering, and/or paying remuneration to induce or reward referrals for items or services reimbursed by federal healthcare programs
  • making prohibited referrals for certain designated health services
  • Examples of Medicare abuse include:

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