Medical professionals often have to deal with very cumbersome billing processes. In most professions, service providers simply bill their clients directly. Medical professionals generally have to go through insurance companies to secure payments.
While this process is necessary and beneficial for many reasons, it can often prove complicated. A medical professional could even face fraud charges for issuing billing information that is not accurate. Here are some of the actions which could cause a medical professional to face medical fraud allegations:
- Billing a beneficiary for medical items or services that were not furnished. An example of this could be a doctor submitting bills for tests and examinations that never occurred.
- Billing for items that represent a higher level of service than that which was actually provided. This process is generally referred to as "upcoding." An example of upcoding could be a medical equipment supplier providing a manual wheelchair while charging for a more expensive motorized wheelchair.
- Billing separately for a set procedures that are covered under the umbrella of one code. This practice is known as "unbundling." A laboratory charging individually for a number of tests that should be bundled and charged under one code is an example of unbundling.
- Billing for items or services that are unnecessary. In the case of Medicaid, each state determines its own definition of what constitutes medical necessity.
Being charged with medical fraud is very serious. In fact, those accused could face both state and federal charges. If you are ever in the position of having to defend yourself against medical fraud charges, you may wish to consider contacting a Louisiana criminal defense attorney. The attorney could assess your records and may be able to help explain and defend your billing processes.