Think compliance is important before? With the recently implemented Affordable Health Act, new powers were granted to some state institutions, which allowed them to more or less convict health care providers on suspicion of fraud.
On Wednesday, August 1, hundreds of federal agents deployed across the country, raided businesses, seized documents and accused 107 suspects in Miami, Los Angeles, Houston, Detroit, Chicago, Tampa, Florida and Baton Rouge, La. payment to 52 providers in the framework of investigations.
“Health and human services have suspended or taken other administrative actions against 52 providers for ... fraud charges. The new health care law, the Affordable Care Act, significantly increased HHS’s ability to suspend payments until the investigation is completed. "(DOJ - Office of Public Relations)
In addition to these new powers, DOJ registered 11 additional private insurance payers to join their Medicare fraud group:
- America Health Insurance Plans
- Amerigroup Corporation
- Association "Blue Cross" and "Blue Shield"
- Blue Cross and Blue Louisiana Shield
- Humana Inc.
- Independence Blue Cross
- National Association of Insurance Commissioners
- Travelers
- Taffeta health plan
- UnitedHealth Group
- WellPoint, Inc.
Additional government agencies constituting the Fraud Force:
- Medicare and Medicaid Service Centers
- Coalition against insurance fraud
- Federal Bureau of Investigation
- Office of the Inspector General for Health and Social Services
- National Association of Medicaid Anti-Fraud Units
- National Association for the Fight against Health Fraud
- National Insurance Crime Bureau
- New York Medicaid Inspector General's Office
- US Department of Health and Human Services
- US Department of Justice
These organizations and agencies will collect data collected from all EHR certified platforms required for speedy use. They will look for any signs of potential fraud. According to the CMS publication, unsigned or even late signed notes should be considered for consideration as fraud.
So what can you do as a supplier to avoid going out of business for suspected fraud?
- Minimize errors made in accordance with CPT (procedure) and ICD (diagnostics) procedures
- Do not complete your subscription or wait for verification before you begin to subscribe to notes (all meaningful use of EHR certified platforms to mark the date and time)
- Do not use the procedure code if it is not the most suitable for diagnosis.
- Consistent use of the same CPT code over and over again, although not illegal, can raise red flags. If your practice does this out of necessity, make sure that each visit is carefully documented, will be more important than ever, and can eliminate unreasonable suspicions.
