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RE: [MedicalBillers] INSURANCE FRAUD?

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  • Lin
    Yes that is absolutely fraud and not to scare you but the laws regarding fraud and abuse can and do apply to all person(s) who knowingly submit claims, even if
    Message 1 of 3 , Dec 9, 2008
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      Yes that is absolutely fraud and not to scare you but the laws regarding
      fraud and abuse can and do apply to all person(s) who knowingly submit
      claims, even if you are an employee your liability is the same. Since you
      are "aware" you are in a very tight spot here so be careful. I would
      schedule a meeting to talk with your new employer and I might even be
      inclined to suggest you document these types of things in the future as well
      as your talk and discussion with the new employer so that you have enough to
      cover your ass. A good rule of thumb is to never submit a claim you suspect
      or know is fraudulent, for example if the provider is routinely billing
      insurance for a fee and charging another fee to the patient and you know
      this is going to happen (again..routinely) don't participate at all, your
      liability in this is the same as the doctors. I have seen office managers
      get into just as much trouble because of fraud as the doctor. I even know
      one who really did not know what she was doing was wrong but was prosecuted
      anyway because she "should have known it was wrong"

      This involved her filing claims while the doctor was on vacation (on his
      direct orders to do so). Crazy yes..but it happens.





      Linda Walker

      Practice Managers Resource & Networking Community
      <http://www.billerswebsite.com> http://www.billerswebsite.com
      A division of K&L Media, LLC
      <http://www.klmediallc.com> http://www.klmediallc.com

      Website Design & Management for the Medical Services Industry









      From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
      On Behalf Of Raynea
      Sent: Tuesday, December 09, 2008 10:55 AM
      To: MedicalBillers@yahoogroups.com
      Subject: [MedicalBillers] INSURANCE FRAUD?




      I have a question regarding making payment arrangements with patients.
      The doctor does a lot of different things from treating the case as
      cash and not submitting to insurance to waiving deductibles or giving
      them in network benefits when we are out of network etc.... My
      question is isn't this considered insurance fraud to bill the insurance
      company one amount and charge the patient something different? The
      doctor just sold the practice to someone else and I don't want to get
      into the same habit of adjusting so much of the income each month? Any
      advice would be greatly appreciated! Any info on what you are allowed
      to do with the insurance companies would be great also.

      Thanks,
      Raynea



      __________ Information from ESET Smart Security, version of virus signature
      database 3677 (20081209) __________

      The message was checked by ESET Smart Security.

      http://www.eset.com



      [Non-text portions of this message have been removed]
    • Melinda
      I m with Lin on this one! Melinda Brown, CMBS Ins Biller ... regarding ... submit ... Since you ... be ... future as well ... enough to ... suspect ... billing
      Message 2 of 3 , Dec 9, 2008
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        I'm with Lin on this one!

        Melinda Brown, CMBS
        Ins Biller

        --- In MedicalBillers@yahoogroups.com, "Lin" <italiandoll1967@...>
        wrote:
        >
        > Yes that is absolutely fraud and not to scare you but the laws
        regarding
        > fraud and abuse can and do apply to all person(s) who knowingly
        submit
        > claims, even if you are an employee your liability is the same.
        Since you
        > are "aware" you are in a very tight spot here so be careful. I would
        > schedule a meeting to talk with your new employer and I might even
        be
        > inclined to suggest you document these types of things in the
        future as well
        > as your talk and discussion with the new employer so that you have
        enough to
        > cover your ass. A good rule of thumb is to never submit a claim you
        suspect
        > or know is fraudulent, for example if the provider is routinely
        billing
        > insurance for a fee and charging another fee to the patient and you
        know
        > this is going to happen (again..routinely) don't participate at
        all, your
        > liability in this is the same as the doctors. I have seen office
        managers
        > get into just as much trouble because of fraud as the doctor. I
        even know
        > one who really did not know what she was doing was wrong but was
        prosecuted
        > anyway because she "should have known it was wrong"
        >
        > This involved her filing claims while the doctor was on vacation
        (on his
        > direct orders to do so). Crazy yes..but it happens.
        >
        >
        >
        >
        >
        > Linda Walker
        >
        > Practice Managers Resource & Networking Community
        > <http://www.billerswebsite.com> http://www.billerswebsite.com
        > A division of K&L Media, LLC
        > <http://www.klmediallc.com> http://www.klmediallc.com
        >
        > Website Design & Management for the Medical Services Industry
        >
        >
        >
        >
        >
        >
        >
        >
        >
        > From: MedicalBillers@yahoogroups.com
        [mailto:MedicalBillers@yahoogroups.com]
        > On Behalf Of Raynea
        > Sent: Tuesday, December 09, 2008 10:55 AM
        > To: MedicalBillers@yahoogroups.com
        > Subject: [MedicalBillers] INSURANCE FRAUD?
        >
        >
        >
        >
        > I have a question regarding making payment arrangements with
        patients.
        > The doctor does a lot of different things from treating the case as
        > cash and not submitting to insurance to waiving deductibles or
        giving
        > them in network benefits when we are out of network etc.... My
        > question is isn't this considered insurance fraud to bill the
        insurance
        > company one amount and charge the patient something different? The
        > doctor just sold the practice to someone else and I don't want to
        get
        > into the same habit of adjusting so much of the income each month?
        Any
        > advice would be greatly appreciated! Any info on what you are
        allowed
        > to do with the insurance companies would be great also.
        >
        > Thanks,
        > Raynea
        >
        >
        >
        > __________ Information from ESET Smart Security, version of virus
        signature
        > database 3677 (20081209) __________
        >
        > The message was checked by ESET Smart Security.
        >
        > http://www.eset.com
        >
        >
        >
        > [Non-text portions of this message have been removed]
        >
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