Private Practice Insights: Anti-Fraud Campaigns

By Stuart A. Bussey, M.D., J.D., UAPD President

Fraud costs the US healthcare system about $65 billion last year from Medicare alone.  The ACA provides the Center for Medicare Services (CMS) with funding to adopt new tools to identify fraud and abuse.  Last year the health care fraud and abuse control program recovered over $4 billion. There will undoubtedly be an increase in audits of our practices.  MAC program safety contractors and OIG investigators will be scrutinizing our claims.

But not to worry.  The threat of an audit is much greater for hospitals and “large” physician practices.  Improper coding for the level of service is the most common practice mistake, especially when an ancillary provider is involved.  For smaller practices like my own the challenge is to reduce mistakes and patterns of errors that could attract the attention of auditors. It is important to put systems in place to prevent fraud.  First, establish a culture of compliance. Make it clear that doctors associated with the practice care about following the rules.  Second, educate and train your staff.   Take advantage of free information from government sources.  Do the right thing when problems arise.  Under ACA the failure to refund an overpayment within 60 days is a potential false claims case.  Build a compliance plan.  Physicians can avoid problems by taking time to conduct audits on their own records.  Use a preventative philosophy and you’ll stay out of trouble.