Wednesday, September 02, 2020

4 Ways Healthcare Providers can Prevent Healthcare Fraud


Healthcare professionals could be hit with million-dollar fines if they're found guilty of healthcare fraud. There's also the risk of being sent to prison or losing their medical license. You don't have to be guilty of deliberately defrauding the government, either. You could face hefty penalties due to errors in billing by your employees that end up costing the government more than it should pay, for instance. That's why you need to do all you can to minimize the risk. Here are fourways healthcare providers can prevent healthcare fraud.

Ensure Accurate Billing

You can be hit with significant fines if your staff accidentally double-bill or over-bill patients and the governmentThat’swhy you need to review medical billing and coding practices so that employees don’t improperly bill for a more expensive service or file a claim for undocumented services. Invest in ongoing training of staff regarding compliance, and set up internal monitoring and auditing to prove it is being done. Ongoing monitoring allows you to identify and correct abnormal billing practices as soon as possible.

Be as Transparent as Possible

Gifts from medical manufacturers can influence provider decisions. This is why the Affordable Care Act requiresmedical device manufacturers, pharmaceutical companies, and biological companies to disclose their gifts to healthcare providers. A healthcare provider's moral obligation is not to recommend expensive or new treatments because they receive these gifts.

If you’ve accidentally filed a fraudulent claim, stop billing immediately and consult with an attorney. This minimizes your legal liability while the attorney can do a detailed risk analysis. If you’ve already been accused of fraud, a team like can connect you with experienced healthcare fraud attorneys who can assist you.

Maintain and Update Your Documentation

Your healthcare facility needs to maintain accurate records. This ensures that you have the documentation to defend yourself if accused of medical malpractice or Medicare fraud. 

You don't want to receive a fine for billing the government for services that they say were not rendered when the real problem is that you didn't document all rendered services. The government's stance will always be that if you didn'tdocument it, the treatment didn't take place.

Be Careful with Your Referrals

Referrals are not as simple as they may seem. For example, the Anti-Kickback Statutes and Stark Law could result in penalties if a doctor refers a patient to another facility when an investor has a stake in both facilities. So, don't accept a partnership with an expectation that you'll send business their way. Unwarranted medical treatments can also waste a patient's time and money, so don't make a referral unless you have solid evidence to back it up. 

Furthermore, you’re obligated to report any conflicts of interest regarding referrals. This could be as simple as telling a patient that you’re referring them to a day surgery center that you partially own while making it clear they have the right to use another facility. If you’re in doubt regarding the legality of a potential conflict of interest, seek legal counsel.


The government can do anything from revoking your medical license, to sending you to prison, or hitting you with fines equal to several times what they say you over-billed the state. This is why you must do everything you can to prevent charges of healthcare fraud.

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