Hi, I was wondering if anyone knows how legal this is. Insurance A (for example BCBS) has a credit balance on a patient's account due to either an overpayment or underbooked charges. Is it legal to post a payment reversal removing that credit, and to post offsetting payment to a different payer and different patient account (for example an unpaid Medicare charge). Net zero transaction.
Obviously this is inaccurate recording of payments to patient accounts because there is no paper trail. However, is there a specific statute that would classify this as fraud or make it illegal? Would this classify as insurance fraud and/or violation of Accounting practices?
Also, it's a skilled nursing facility nursing home provider.
Thank you for your input, I appreciate it