Medical Billing Companies: Are you liable for submitting false claims?

This article was originally posted by Stephen D. Bittinger on Linkedin

While the majority of my clients are physician groups or larger private healthcare entities, we have seen an increase in the number of medical billing companies being caught up in litigation with clients and entangled in False Claims Act cases. For all my medical billers out there, please answer these questions:

1. Does your company have sufficient billing errors and omission coverage to defend the level of risk involved with your client base? If not, it’s like going into battle without armor.
2. Does your company have clear, concise contracts with clients that delineate your company’s responsibilities in the billing process from the practice/provider’s responsibilities? When providers get in trouble in payors, one of their first steps is to point the finger at their billing company.
3. Does your company have a screening process to ensure that a new client coming on board is not already tangled up in a mess with payors? No matter how good of work your billing company does, you’re not going to get paid if you start servicing a black-listed provider.
4. Do your billers know enough about each payor’s reimbursement policies for the services being billed to identify if you are submitting false claims for a providers? If not, the failure to become educated can be disastrous: https://www.justice.gov/usao-ndny/pr/medical-reimbursement-systems-inc-pay-500000-resolve-allegations-it-submitted-false

Billers – bucket up and stay safe! Healthcare reimbursement is a minefield!