How do deal with fraud

Specialties Advanced

Published

Nurses Month 2024 | Discounts & Freebies AORN Celebrates Nurses Month

If you noticed your information was used to bill insurance companies you have never seen how do you deal with this to make sure you don't get in trouble. I don't submit my own bills, someone in the office does.

Up Vote Up Vote ×
Specializes in Flight, ER, Transport, ICU/Critical Care.

Swiftly. You to determine the scope of the issue. An outside audit may be necessary. Your practice manager may not be able to determine a "billing issue" — or it could be an isolated mistake. Not sure where you practice or what payor type patient you found the error on.

Not it trying to be "cute", but if you are part of a large group and you noticed an anomaly, this is a potential problem. Hopefully, this is isolated — tho in my experience, that is unlikely. If it is Medicare and involves overpayment and it is a systems issue, this could be a major problem. CMS rules on provider billing and payment are strict.

End of story, potentially serious — requires immediate further investigation.

Or there could be other nefarious shenanigans. Trust, but verify.

Good luck.

I'm in a place where my faith in humanity is low. I hope it is innocent. í ½í¸‡

Up Vote Up Vote ×
Specializes in Reproductive & Public Health.

Seriously serious. At least potentially. Did you reach out to billing? That's an obvious first step. I can't imagine any office committing such brazen insurance fraud on purpose, so I would assume it is something innocuous like a computer problem or confused new hire or something.

You should speak up about this like yesterday. You and your clinic could get into serious hot water, if it's not addressed quickly.

Up Vote Up Vote ×
+ Add a Comment