Compliance: Medicare Biller Gets Jail Time and Millions in Fines for Fraudulent Claims

Why This Topic Matters

It helps readers understand why billing oversight matters, how outsourced billing arrangements can create compliance risk, and what general safeguards practices may consider when working with third-party billing services.

Article Sections

1. Verdict

   Summarizes a fraud case involving a medical biller and the resulting legal consequences. Introduces the compliance concerns that motivate the rest of the article.

2. Check in With Billing Services

   Outlines general oversight considerations for practices that use external billing support. The section presents several high-level themes for evaluating billing service compliance, communication, and accountability.

3. 1. Ensure the Service Understands Compliance

   Discusses the importance of having a billing service that recognizes compliance concerns and supports a practice’s internal policies. References the role of compliance programs and ongoing updates.

4. 2. Peruse the Fee Arrangement

   Reviews billing-service compensation as a compliance risk area and notes that certain arrangements may raise concern under federal and state rules. Focuses on broad fee-structure considerations.

5. 3. Find A Contact Person

   Emphasizes the value of having a clear point of contact at a billing company. Highlights communication, follow-up, and accountability between the practice and the billing service.

6. 4. Maintain A “Check-In” Arrangement

   Addresses ongoing communication between a practice and its billing support. Encourages routine interaction and accessibility for questions or concerns.