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Recourse for negligent billing service costing our practice thousands!?

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PMRNC:
It is scary. If you think about it the law is clear on fraud and abuse and not only does it state it's illegal to submit a fraudulent claim or commit abuse.. but that anyone BILLING SHOULD know, so it's not all about "mistakes" For example I read one case where the biller knew the provider was billing for visits when he was not in the office, but maybe she felt compelled since he was the boss, anyway both of them ended up in court with hefty fines/penalties and I think even some jail time. Some of those cases are pretty scary. I used a lot of cases to help me put together my contract .. good idea huh?  ;D

Michele:
I misunderstood the question, I thought you were asking more if the provider could hold the biller legally responsible if they did a poor job and caused the provider to lose money. 

Linda is right, the biller cannot do something that he/she knows is not legal just because the 'boss' tells them to.  If they know (which they need to!) that it is illegal then they have to not do it, even if it means losing their job.  Finding another job is better than jail time.

We had a provider that was charged with fraud, billing for patients that were not seen.  Being an outside billing service we obviously did not know the patients had not come into the office.  We cooperated fully with the investigation, showing all the documentation to prove that we were provided with which obviously indicated the patient had been seen. 

You have to protect yourselves and knowledge is the best way.

Michele

PMRNC:

--- Quote ---We had a provider that was charged with fraud, billing for patients that were not seen.  Being an outside billing service we obviously did not know the patients had not come into the office.  We cooperated fully with the investigation, showing all the documentation to prove that we were provided with which obviously indicated the patient had been seen.
--- End quote ---

There was a billing company in NC I believe that wasn't so lucky. You see they had to go to court because the laws on fraud/Abuse include verbiage that billers "Should know" apparently what happened is the blling company suspected and rather than cease operation on their billing they decided to conduct their own investigation, in court they lost because they SHOULD know. I know they tried to appeal the decision but I never found out what happened in the end.
I caught a provider who was supposed to be "supervising" a biofeedback tech, I got a daysheet faxed to me for a days worth of biofeedback services, problem was my client had called me from Florida to tell me he was having a wonderful vacation, that very morning.  :o I contacted him on his cell and told him and he said he has done that before and "no one would know" Well I knew and that's when I terminated him, did NOT bill the charges received that date and turned them both in. I also documented everything leading up to me finding out to CMA.

Linda Walker
PMRNC
www.billerswebsite.com

Pay_My_Claims:
oooooh, I live in NC  :o

PMRNC:
I'm pretty sure it wasn't you.. you are too smart for that!  ;D 

Linda Walker
PMRNC
www.billerswebsite.com

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