Practices to reduce the risk of Medicare fraud

On Behalf of | Feb 14, 2024 | Blog, Medicare and Medicaid Fraud

Medicare fraud is a serious issue that costs the government billions of dollars each year. Healthcare providers can avoid fraudulent actions by adopting ethical practices and staying informed about regulations.

Taking the right steps to maintain integrity can work in your favor in a Medicare fraud investigation.

Maintain comprehensive records

Thorough records of patient care can help you avoid or face fraud allegations. Keep detailed documentation of diagnoses, treatments and medical necessity for services. This step ensures that your Medicare claims accurately reflect the care delivered.

Understand and follow coding guidelines

Healthcare providers must use the correct codes for diagnoses and services when submitting claims. Stay updated on coding guidelines, as repeated errors can lead to suspicions of fraudulent billing. Regular training for staff on the latest coding practices helps prevent mistakes.

Create a compliance program

A comprehensive compliance program lets you detect and prevent inaccurate billing and fraud. It should include regular audits of billing practices, employee training on Medicare policies and a clear process for reporting fraud. Emphasizing compliance supports a culture of integrity and accountability.

Avoid unnecessary services

Only provide services Medicare considers medically necessary for the patient’s health condition. This ethical practice not only avoids legal trouble but also upholds the quality of patient care.

Stay informed about Medicare policies

Medicare policies and regulations often change. Regularly review Medicare guidance and participate in training sessions so you know how to remain compliant.

In 2022, healthcare fraud offenders received an average of 30 months in prison. Only 21.3% of those prosecuted avoided incarceration. Diligence and careful attention to detail can help shield your medical practice from the impact of Medicare fraud accusations.

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