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Preventing Medical Billing Fraud

According to experts in medical billing, the government loses thirty cents per dollar earned due to fraudulent practices that happen in the medical community. Medicare fraud is a felony and suppliers, recruiters, providers, beneficiaries and companies of medical services can commit it. Types of medical billing fraud include writing bills for services that have not been provided, billing services that are not covered as services that are covered and unbundling of services among other activities.

There are many ways in which an office can prevent billing fraud. One of these methods is through screening employees. Any employee applying for a position as a medical biller should pass through screening, which involves performing a background check and asking to see the candidate's billing certificates.
The other way to prevent medical billing fraud is to set up a compliance program that will allow you to prevent fraud.

Such a program should be overseen by personnel granted the responsibility to recommend consequences once he or she detects fraud. The reason of the program should be communicated to all employees, letting them know of the procedures and standards involved in it. The other thing that an employer can do to prevent medical billing fraud using the compliance program is to include a method designed to report abuses without fearing penalty and retribution if an employee breeches the standards of the program.

The other way in which billing fraud can be prevented is through compliance with the Health Insurance Portability and Accountability Act (HIPPA), which is a federal legislation that is intended to offer protection to a patient's personal health information and privacy.

This legislation ensures that a patient's protected health information, which includes any information that can identify a patient, is kept secure. This information includes patient names, medical records, social security numbers and addresses.

The precautions that an office can follow in order to ensure that the information remains secure includes ensuring that computers are password protected so that others cannot view patient information, ensuring that fax machines are placed in areas where the public cannot access them and encrypting emails that contain patient information. In addition to this, the people having access to a medical billing office should sign a confidentiality statement.

These practices should apply also to a third party medical billing service and this can be done through the use of business associate agreements and contract clauses.


  1. How many of these young patients have refused evaluation for transplant to continue receiving their monthly checks from the government in perpetuity?? There needs to be some kind of policy enforcing a timetable.
    Bill Clinton sucessfully placed limits upon welfare benefits during his administration. The same needs to be done with potential transplant recipients.

  2. As much as three quarters of hospital staff are usually burdened with some sort of billing-related work in a traditional billing system. Opting for electronic medical billing solutions (ones that come with free EMR plans) that fit easily into the healthcare business' workflow are key to freeing up staff resources.

    Physician Billing Services
    Medical Billing Services


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