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Ways you might be committing health care fraud

As a doctor in New York, you are probably used to hectic days where, by the time you are leaving for the day, it is hard to tell up from down. While you devote your full attention to every patient in order to provide the healing they need, you may rush through the administrative part of the job.

Unfortunately, if you or your staff are consistently making billing errors, you could end up facing a health care fraud charge. The following are a few ways you might be committing fraud as a medical professional.

Billing for services you did not provide

Perhaps you made a note on a patient's chart about a service or care you fully intended to provide, but during the exam you determined the treatment was unnecessary. In your rush to get to the next patient, you did not correct your notes and, as a result, the administrative staff included the billing code for those services on the insurance claim form. Billing for service you did not provide is a form of health care fraud. Some medical professionals who intentionally commit fraud go so far as to file claims for services provided to completely fictitious individuals.

Falsifying visit dates

In many cases, medical providers can receive higher payments from insurance companies by billing for services on separate dates instead of filing the full claim on the day they actually provided the services. For example, if a patient comes in for an office visit and receives two separate treatments, the insurance company will pay less for one visit than if the medical provider bills the separate treatments under different dates.

Waiving a patient's out-of-pocket payment

Most insurance companies require that patients make out-of-pocket payments such as co-pays and deductibles. Some medical providers waive these patient payments and instead up-code or add additional services to the insurance claim in order to make up the difference. While most patients will not complain about such a waiver, the provider is actually committing fraud.

If you are a doctor or other medical professional and you are facing charges for health care fraud, it is important to remember that you have rights and options. With a proper defense, you can fight back against the charges and possibly avoid a conviction.

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