What Not to Do When You’re a Medical Facility or Private Practice Owner

A Vancouver chiropractic clinic owner was ordered to pay an $88,846 settlement after it was discovered that he had improperly billed clients for its wide range of services, according to a report on the BLS Courier Herald. The settlement was given to the Washington Department of Labor and Industries.  

Dr. Lucas Homer, the clinic owner, also had another business- Cascade Park Sports Medicine and Rehab PLLC, which was also faced with fines costing $452 and $47 in trial costs, after the company was found out to be guilty of attempted second-degree theft.

The clinic entered an agreement with the state agency to provide covered injured workers physical therapy and therapeutic massages. The Vancouver clinic saw it as a money-making opportunity. Based on records gathered by the Washington Attorney General’s office, the clinic billed the agency for hundreds of bogus appointments that were falsely reported to have taken place for a period of two years, beginning on March 1, 2009, up to September 15, 2011.

The clinic had two tactics: for one, claiming it also rendered services on a particular day for the worker  other than the real date of their appointment (upcoding and billing); and allowing uncertified employees to render massages and physical therapy services, then using the number of certified personnel on the bill at the event of billing. 

It was textbook fraud and at its finest. Unfortunately, no secrets are left hidden. The dirty secret had been revealed following a Labor and Industries investigation. L & I investigations leader Annette Taylor tells BLS Courier Herald that the department is thrilled that the workers have been compensated for the inconvenience.

Taylor added that the department monitor whether providers are billing patients correctly and providing them the healthcare services covered by their fringe benefits. “When providers don’t do that, we catch them,” she said. 

It’s really astonishing that some healthcare providers blatantly commit such acts of fraud when they know that the risk of getting caught—or, rather, jailed is too high. Remember, especially if you work as a medical biller and coder in a facility, that a single typo and intentionally manipulating patient records for financial gain already constitute as fraud. Don’t be greedy and always think of the consequences of criminal fraud. The word criminal won’t be used to describe it after all if it’s not punishable by law.   

Resources:

• http://www.blscourierherald.com/business/233934581.html
• http://www.meditec.com/medical-billing-training/
• http://en.wikipedia.org/wiki/Medical_billing