The historic implementation of the Patient Protection and Affordable Care Act in the United States has set healthcare providers in a stiff situation. Now, more than ever, the healthcare outsourcing industry has further proven that it could be a very valuable asset to anyone.
With over 32 million new customers to cater to, healthcare providers have turned to outsourcing companies to bolster their capabilities to accommodate the newly implemented guidelines and increase business process requirements. This includes new customer enrollment, customer service, claims processing, revenue cycle management, and medical billing services. The medical outsourcing industry has demonstrated how they can be useful with their proper utilization of technology and manpower. However, these don’t make them safe from the prying eyes of entities that would do anything to take advantage of other people.
Medical billing fraud is one of the challenges that medical outsourcing companies face. The most common type of fraud usually involves stealing personal information which often leads to identity theft. In the field of medical outsourcing, it is used in a variety of ways to avoid payment, get extra benefits, or to maintain benefits they no longer qualify for. Even some healthcare providers have been reported to be engaging in medical billing fraud. And with the surge caused by the Patient Protection and Affordable Care Act, it would be no surprise if someone will exploit these legislations for medical billing frauds.
The best way to protect you from these medical billing service anomalies is to get familiar with it. The following are just some of the existing methods the industry has experienced to date:
- Made-up claims for services or supplies that never really occurred
- Identity theft or using someone else’s medical insurance information to obtain services or supplies
- Falsification of signatures or medical records to support misrepresented services or supplies
- Unbundling services from a group to unlawfully increase medical payment
- Misrepresenting the location where services or supplies were provided
- Rendering medical care without a license
- Duplicate claim submissions
There are already existing government laws that protect us from such medical billing frauds including The Health Care Fraud Statute, The False Claims Act, The Anti-Kickback Statute, Exclusion Provisions, and The Civil Monetary Penalties Law. The US Department of Health & Human Services together with OIG or Office of Inspector General acknowledges the damages that healthcare frauds can bring. Together, they are working to enlist the health care industry and the public in the fight against fraud. OIG website even offers extensive information to health care providers and patients about ways to reduce the risk of fraud and abuse.
Medical Fraud is an issue that shouldn’t be taken too lightly. It costs taxpayers billions of dollars every year and requires focused attention and commitment to solutions. As an individual, it is our obligation to remain vigilant and to keep our eyes peeled for issues that concern our safety.
For a safe and secure medical billing service provider, Infinit Healthcare can help you! Quality and Security Guaranteed!
