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Fraud, Fines, and Prison Time: Healthcare in Michigan, January 2018

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Did you know every physician practice is required to have a compliance plan?

Healthcare fraud is rampant in Michigan and the federal government is cracking down on healthcare practices.  An Oakland County physician practice biller was recently ordered to pay $3,252,107 in restitution and sentenced to 50 months in prison. The biller was convicted of mail fraud and of conspiracy to commit health care fraud, wire fraud, and mail fraud.

These convictions were passed down as the biller knowingly submitted fraudulent bills on behalf of a physician, for services she knew were not rendered. The physician paid her 6% of the total billings from Medicare. The case was investigated by the FBI and the U.S. Department of Health and Human Service Office of Inspector General (“HHS-OIG”). 

How can you protect your practice from fraud and fines? There are many things you can do to make sure that you don’t share this fate.

  1. One essential thing to do to for your practice is to perform an external audit to catch potential billing errors. Audits serve many functions and can help to catch mistakes before it’s too late.
  2. It is also critical that you train your staff on both HIPAA and compliance regulations, as well as on the potential sanctions that come with violations of regulations.
  3. Your staff and all physicians must also be trained on billing and coding, to make sure that physicians in your practice are not upcoding or billing for services not rendered. Physician billing and coding is under constant scrutiny from the government and insurance companies.
  4. Ensure that your practice has open lines of communication so that physicians, staff, and billers feel free to communicate their compliance concerns and questions. Make sure to have a way for all staff to anonymously report their concerns.
  5. Finally, follow through. Make sure to take all potential compliance concerns seriously. Investigate allegations and make the necessary changes to prevent further issues fr3m arising. Let your staff know that you take their compliance concerns seriously.

Always remember that compliance is an ongoing process and compliance education should be ongoing at your practice.

Contributed by: Lori-Ann Rickard of Rickard & Associates, P.C. a multi-specialty law firm serving corporate and individual clients. Rickard & Associates is a member of TPA’s Affiliate Partners program. With over 30 years of experience, Rickard & Associates has specialty practices in healthcare law, corporate transactional law, litigation, and employee relations. Rickard & Associates has certified coders who can assist in audits and/or training your staff. Contact Rickard & Associates, P.C. at (586) 498-0600. TPA members get discounts on rates!

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

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