Provided by: Jennifer Kirschenbaum, Esq.
March 6, 2024
Question:
Jennifer,
Jennifer,
I just discovered a provider I employ has no medical notes. I have submitted billing for this person. What do I do now?
Thanks,
Dr. M
Answer:
We need to talk.Call me for specific advice. Generally, to start, for those claims submitted, without medical record support the Practice would not be entitled to reimbursement. You will have to consider self-disclosing and refunding on paid claims. The provider has committed professional malpractice, possibly breach of contract (depending on what you have had the provider sign) and depending on which payors are involved, a crime. The reasons behind the lack of documentation, the providers status and ability to address, all will factor in to our assessment.
The facts here matter, and will dictate next steps. Let’s act swiftly.
Thanks,
Dr. M
Answer:
We need to talk.Call me for specific advice. Generally, to start, for those claims submitted, without medical record support the Practice would not be entitled to reimbursement. You will have to consider self-disclosing and refunding on paid claims. The provider has committed professional malpractice, possibly breach of contract (depending on what you have had the provider sign) and depending on which payors are involved, a crime. The reasons behind the lack of documentation, the providers status and ability to address, all will factor in to our assessment.
The facts here matter, and will dictate next steps. Let’s act swiftly.
