OIG is implying we should have known betterHas OIG suggested what you should have done differently?
Keep us posted on how this plays out.
if Medicare denies payment for a charge that the doctor has not given us a signed ABN for, we automatically write off the charge, no questions asked. Medicare denied payment, patient was not billed, no question at all of whether there are legal issues involved. The patient is not billed and that ends it.
Quote from: RichardP on February 09, 2013, 10:32:49 PMOIG is implying we should have known betterHas OIG suggested what you should have done differently?No.
Fraud and Abuse laws in general include verbiage to say "should know", maybe that's what he is referring to:he civil monetary penalty for healthcare fraud has been increased from $2000 to $10,000 for each item or service for which fraudulent payment has been received. The monetary assessment has been increased from not more than twice the amount to not more than three times the amount of the overpayment. Two practices have been added to the list of fraudulent activities for which civil monetary penalties may be assessed: Engaging in a pattern of presenting a claim for an item or service based on a code that the person knows or should know will result in greater payments than appropriate Submitting a claim or claims that the person knows or should know is for a medical item or service that is not medically necessary
Federal Civil Monetary Penalties (Section 1128A of the Social Security Act/42 USC 1320a-7aa). Health care professionals and entities are prohibited from presenting or causing to be presented claims for services that the individual or entity "knows or should know" were not provided as claimed. services.
If they cannot prove fraud, the biller remains untoasted. The powers that be have never only accepted that billers were doing what they were told. They have always looked for fraud, regardless of what the biller said.
Sometimes a biller needs to play devil's advocate in the best interest of all parties.