There 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.

Technological advances have improved processes in multiple professions, including the medical profession. One significant change is how doctors and other medical professionals’ access and update patients’ medical records. No longer are patient histories, vital signs, symptoms, treatments, and other information written to medical records by hand. Instead, the majority of medical providers now use electronic health records (EHR). While this technology is supposed to be more efficient, there are still issues with accuracy and errors, which could result in professional complaints and even more serious ramifications.

What Are Electronic Health Records?

An electronic health record is a digital version of a medical chart that contains all of the information regarding a patient’s health. Some of the information the record contains includes:

• Patient demographics

  ...

When you look at that medical license you have hanging on the wall in your office, you know the years of dedication it took to obtain it. The education, training, and sacrifices that were necessary to get to where you are today. But that license – and your entire career – is vulnerable to allegations of any kind of wrongdoing. If you have been notified of an investigation by the Medical Licensing Board of Indiana due to accusations or complaints, your medical license could be in jeopardy. The following are some of the most serious acts that can result in an investigation.

Criminal Conviction

If a physician is convicted of a crime, the medical board will usually move to suspend that doctor’s medical license. One of the most common criminal convictions that can result in a temporary medical license suspension is DUI, however, convictions of harassment, stalking, or sexual assault can also result in actions taken against your medical license.

Substance Abuse

Any individual who is abusing alcohol and/or drugs puts themselves and others at risk because of the impact these substances have on their thinking skills, judgment, and mental health. A doctor who has a substance abuse problem could be literally creating a life-or-death situation, putting patients’ lives at risk because of their substance abuse.