Most physicians are geared to provide treatment and care and are not focused on billing and accounting practices. Decisions of how and what to bill are often left to a staff with a smattering of experience who often pick up bad habits from other offices and use them in their new employment. A provider who acts in complete good faith with regard to the provision of treatment or care, and who in good faith relies on a person with some background or experience in the area of billing, may be open to a criminal prosecution because a prosecuting agency determines that there was a misuse of an appropriate coding system. These kinds of mistakes cannot only be costly to defend, but can have disastrous consequences on the provider's license. To make their quotas, investigators may well start with a list of which practitioners have the highest number of dollars in insurance claims each year.
Larger recoveries lead to more funding and faster promotion.
In the event you are reading this too late and are in the midst of one of these nightmares, there are steps you can still implement that may mitigate or even resolve your problems while still maintaining your license and livelihood. All businesses, regardless of their size, should have a quality control division which is geared to inspect, detect and correct the operation of the office and its personnel. Doctors are sensitive to malpractice issues, but they are not as sensitive and aware of the changing laws and regulations which affect the operation and administration of their office such as billing, reports and personnel issues. Having a lawyer inspect, detect and correct your office is the only safe way to know if you have any hidden liabilities. Once a chronic problem has been detected and corrected, you still need to have a maintenance program to keep the practice in optimum legal shape.