Billing fraud or medical billing fraud is the act of any person or organization, who tries to defraud the state through any medical assistance program created under the federal Social Security Act, and administered by the Department of Health and Hospitals through false bills. Many people commit such frauds to claim money from Medicare program illegitimately. Medical billing fraud is a big problem in the United States which costs the American health care industry billions of dollars every year. Several parties including patients, doctors, insurance companies and pharmacists etc., commit such frauds by presenting bills with altered invoice amount. While patients try to get reimbursed for services they never paid for, hospitals and doctors commit the same fraud by issuing bills to their patients and to the insurance companies for the services that they have never offered. This article answers some of the frequently asked questions on billing fraud and laws associated with it.
Is it possible to bring a sealed misdemeanor medical billing case conviction to a court years later?
Though it is generally used during the penalty phase in a trial, but you can do this in most cases as sealing or closing a file doesn’t always prevent it from being used in future. There are some circumstances where it could be used in the guilt or innocence phase, but it is usually used only in the punishment phase of a trial. Would it be considered as a fraud, if an organization is billing Medicare reimbursement for a licensed physical therapist while without having one on it’s pay-roll?
This act could be considered as a billing fraud. The organization can be held criminally liable along with the employee for his role in this fraud. Will it be considered as a billing fraud, if a major hospital has billed someone twice for the same date and the same amount with different patient numbers?
This may or may not be considered as a billing fraud. It might have happened due to an operational error or could be the result of a small oversight as many times billing companies assign different patient number for different dates of service. Once it is reported, the company should try to rectify the same. However, if it could be proved that this has been done with a reasonable fraudulent intention, this should be treated as a billing fraud case. Would a person who handles billing for a doctor from a different clinic be liable for a double billing? What steps need to be taken to protect the billing party in this case?
In this case, both the billing party and the doctor could be held liable for billing fraud. To safeguard the billing party in such a case, there should be a contract in which the clinic should acknowledge that the billing party submits the bills based on truthful information provided by the clinic and the billing party has no independent knowledge on the accuracy of the information provided to him/her. It would be advisable to include a clause of responsibility where the clinician takes absolves the biller of liability as long as the bills raised are as per the information provided by the clinician. I was convicted in a billing fraud case and continued working in the same field after finishing probation and restitution for over 25 years. Is it discrimination to be terminated because of the earlier conviction?
Your termination could be considered as a workplace discrimination against you only if you could relate the treatment towards you to some type of actionable discrimination. Without a having a written agreement between you and your employer in this situation, it seems that you may not have a case. Your termination because of an earlier conviction in the billing related fraud may not be ground for a discrimination case. However, if you feel that you have been terminated on grounds of race, religion, sex, national origin, age, disability, past, current, or future military obligations etc., which are protected by federal law, you can always file a charge of discrimination with the Equal Employment Opportunity Commission (EEOC) within 180 days. Billing frauds can happen intentionally or unintentionally. To be on safe side, it is always better to be well informed about the law. You should ask a criminal lawyer who can guide you whenever you face any issues related to billing frauds.
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