Time and time again, the government has proven that no one is immune from accusations of healthcare fraud. Certainly not providers, but also coders, billers and office managers.
Check out three cases of office managers who were accused of healthcare fraud, what the allegations were and how you can avoid similar issues.
1. MO Office Manager Accused of Billing NPP Services as if Doctor Performed Them
An urgent care physician and his office manager were indicted in July for health care fraud charges stemming from accusations that they billed services to Medicaid and Medicare indicating that the doctor had performed the services, even though they were actually performed by assistant physicians.
The practice allegedly brought on assistant physicians (APs) to perform services they weren’t legally able to perform without supervision. The government says the supervising physicians weren’t actually present continuously, yet the office manager and doctor reported their services as if the doctors were on site. The office manager and doctor could face prison time, a $250,000 fine, or both.
2. Billing for Psychotherapy Not Performed
In March, a New York office manager and physician were charged for fraudulently billing Medicaid for upwards of $700,000 over a four-year period.
The office manager and the physician allegedly submitted to claims to Medicaid and other payers for psychotherapy sessions that never happened, according to the district attorney. In addition, they are accused of writing prescriptions for controlled substances in exchange for cash. The prescriptions were later paid for by insurers, including Medicaid payers.
3. Dental Practice Billing Medical Procedures
A California dental office manager and dentist pleaded guilty in October to allegations of defrauding Medicare and then trying to hide their crimes from view.
The dentist is said to have billed Medicare for medical services like bone grafts, despite having actually performed non-covered services like tooth extractions instead. When questioned by the government, the office manager and dentist apparently submitted false documents to their MAC to try and cover up the crime. Over the course of two years, the dental practice is believed to have collected $8.4 million from Medicare for false claims, the DOJ said.
Avoid This Fate
Medical office managers are certainly not immune to accusations of fraud, and the penalties are extremely steep, potentially involving jail time and massive fines. Your best bet as a practice manager is to immediately report any wrongdoing that your practice is involved in rather than trying to cover it up or hide it. In addition, if a provider asks you to get involved in a scheme, you should contact a whistleblower line to report the fraud.
Compliance is an ever-evolving topic, and is changing again for 2024. Get the scoop from healthcare attorney Amanda Waesch, JD, during her online training, New 2024 OIG Healthcare Compliance Program, Avoid Audits/Fines. Register today!
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