Billing and coding errors can be just that: Errors that were made innocently. Unfortunately, a person involved in the medical field could end up charged with healthcare fraud for a simple mistake. Keep reading to learn which billing and coding errors most often lead to fraud charges. Call Law Office of Michael L. Fell at (949) 585-9055 for a free legal consultation if you have been charged with this or another theft crime.
Whether it’s due to a mistake or intentional deception, medical coding errors are becoming a significant issue in modern medicine. When it comes to healthcare fraud, billing, and coding errors are the most common forms. Honest mistakes can even be prosecuted under the False Claims Act. The charges could be either civil or criminal and come with some pretty severe consequences. Whether you’re a practitioner who has made a mistake or a patient who’s had an error made on his or her file, it’s often necessary to hire a healthcare fraud lawyer.
This is the most commonly charged type of medical fraud. It involves a medical provider billing for a more complex and expensive procedure than was actually done. This can happen by accident, and it is a severe issue when it does. Insurance companies end up taking on most of the cost and the patient often does not realize that they have been upcoded at all.
If there are components bundled together and billed together, and the biller and/or coder bills them separately, this is known as unbundling. It almost always results in higher overall prices. Think of it like going to your favorite fast food restaurant and ordering a value meal, only to be charged for each part individually. Unbundling can happen by accident when the biller and/or coder simply doesn’t know or forgets that items should be bundled together.
Coding a Wide Range of Diagnoses
The law requires that only confirmed diagnoses can be coded. If a doctor or coder adds codes for several conditions the patient may have, this can make it appear as though the patient is being seen for more conditions than they are actually receiving treatment for.
If patients regularly have changes to their diagnosis even though their symptoms and complaints have not changed, then there is an issue with inconsistent coding. This can happen when the procedures the doctor has listed are not the same as what is on the surgery center’s statement. This most often happens either right before surgery or another expensive procedure.
If you have been charged with this crime, then you need to find an experienced criminal defense attorney as soon as possible. You can reach Law Office of Michael L. Fell at (949) 585-9055 now for a free legal consultation. We are standing by to help you find the best way forward.