Call Today for a Free Consultation


Allegations of Healthcare Billing Fraud Can Result in Loss of Medical License

Posted on in Medical license defense

indiana medical license defenseThere is no denying that the healthcare billing system is a complex one, whether you are dealing with private insurance or government insurance, such as Medicare and Medicaid. There are multiple codes and processes to keep track of, which can be difficult because of the way things are always being updated and changed. Unfortunately, billing errors do occur. Even more unfortunate is that some of these errors can lead to allegations of healthcare billing fraud, putting a physician’s medical license – and even their freedom – in jeopardy.

What Are Examples of Healthcare Billing Fraud?

A physician or other medical provider can be accused of healthcare billing fraud if there is evidence that they intentionally manipulated the insurance billing system or coding to their advantage. One common type of fraud is referred to as upcoding. Upcoding occurs when a patient receives bills from the provider for services that are more expensive than the actual services they received.

Another type of healthcare billing fraud that occurs frequently is when a provider submits the same bill more than once to the patient’s insurance company for a service or procedure the patient only received once.

The third common type of healthcare billing fraud is referred to as unbundling. This is when a patient has a procedure but the provider bills the insurance company one bill for each stage of the procedure as if these stages were separate procedures instead of one bundle.

What If the Billing Fraud Was Unintentional?

Not all allegations of healthcare billing fraud occur because a provider is dishonest. There are many cases where the mistakes are genuine errors. However, it is critical that providers protect themselves. Some of the steps that can be taken to prevent these serious situations include:

  • Making sure either in-house billing staff or outsourced billing services are competent and fully trained

  • Making sure there are strict internal policies and procedures in place to prevent errors and detect any claim issues. These can include cross-checking forms and even utilizing external auditors

Consequences of Healthcare Billing Fraud

A provider who is found guilty of healthcare fraud can face significant penalties, including high fines, loss of their medical license, and other civil penalties. In some cases, the provider can even face criminal penalties. The impact of these consequences can mean huge personal and financial losses.

Contact an Indiana Professional License Defense Lawyer

If you have been accused of healthcare billing fraud, do not delay in calling a skilled and experienced Indianapolis, IN medical license defense attorney for legal help. Call The Law Offices of Joseph J. Bogdan, Inc. at 463-219-2612 to schedule a free consultation.


American Pharmacists Association Better Business Bureau elite lawyer SuperLawyer avvo
Back to Top