Bogus billers can leave physicians on the hook
Liability for fraud can fall on doctors
Besides the headaches that come from getting unknowingly entangled in a criminal investigation, otherwise innocent providers can be held liable for repaying any fraudulent Medicare overpayments obtained by unscrupulous outside billers in their names.
While physicians feel this is unfair, many lawmakers think it is the best way to police the program. "It’s a simple solution: Look to the health care provider with the deep pockets" to repay Medicare, says Rep. Ed Bryant (R-TN). "Doctors are smart people. They have to get the message that they will be held responsible."
That means it’s crucial for providers to check the credentials and track records of the firms they hire to process claims and to do regular audits of the bills submitted in your practice’s name. Even then, there’s no foolproof assurance you won’t be hoodwinked because con artists still can arrange to have remittances and other paperwork sent to a dummy address.
Some 5,000 third-party billing companies prepare and submit claims for physicians and providers to Medicare, Medicaid, and private health insurers. Medicare, alone, processed more than 700 million Part B claims last year.
To improve oversight, the Health Care Financing Administration (HCFA) hopes to release new rules in a few months requiring regular verification of information of any third-party billing arrangements involving physicians in Medicare and other government health programs.
Even after the agency’s new enforcement efforts go into place, there is "nothing we do that can take the place of, or be as effective as, physicians asking questions of billing companies and monitoring their account activity," says Penny Thompson, HCFA’s director of program integrity.
For instance, if your billing company codes claims, Thompson suggests you verify that the firm is certified, examine its quality control program, and determine whether it has a compliance program.
Contracts between you and the billing company also should be scrutinized, advise health care lawyers. Of particular interest is language outlining each party’s responsibility when it comes to claim documentation and code selection.
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