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Why all the heat?

Provided by: Jennifer Kirschenbaum, Esq.
January 30, 2017
Question:

Jennifer, 

Why does it feel like as doctors we're getting so much heat lately?  I have audits coming in, and stress over employees.  Is it just me?

Dr. I

Answer: 
 
No.  It is most definitely not just you.  A good portion of my job is being a counselor - listener -and I'm hearing that many of your colleagues are going through the same. Audits, pressures from staff AND patients alike, fear of reporting - its tough out there.The level of oversight has gone from moderate to severe in the past 10 years. Especially for the feds related to federal funding - Medicare and Medicaid monies. Why? There's money in it for them - specifically - your money that you have billed for (hopefully) legitimate services.  So, why the effort?  There are some "bad dudes (and dudettes)" out there - which you can see from the case the government makes through its propaganda headlines - 

January 27, 2017; U.S. Department of Justice

Three Individuals Plead Guilty in $55 Million Health Care Fraud Scheme at Two Brooklyn Medical Clinics

January 27, 2017; District of Idaho

Fruitland Woman Pleads Guilty During Trial to Health Care Fraud and Aggravated Identity

January 25, 2017; U.S. Department of Justice

Clinical Psychologist and Owner of Psychological Services Centers Convicted in $25 Million Psychological Testing Scheme Carried Out Through Eight Companies in Four Gulf Coast States

January 25, 2017; U.S. Attorney; Central District of Illinois

Co-owner of Chicago Medical Transport Company Sentenced to Five Years in Prison for Overbilling Illinois Medicaid $4.7 Million


Guilty. Guilty. Guilty. 

And, maybe so. Innocent people don't fork over millions of dollars and agree to jail time (usually).  We have cases of the few ruining it for the many.  What I will say, as serving as counsel to healthcare fraud matters (which I do, because unfortunately there is a need), especially in these matters where medical necessity may be an issue, or documentation - there are absolutely 2 sides to each story - and the "facts" are not as presented by the government - most of the time.  

How do you sleep at night?  Work to preventatively protect your practice by having an expert check your documentation, confirm your patient and staff policies and procedures - and do the best you can to do the right thing (best you can estimate).  Work with your team, which includes me, your healthcare attorney, to stop problems before they start and get out of control. 

Sparks are much easier to put out then flames.  


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