Compliance: Protect Your Practice with 5 Tips to Combat Fraud and Abuse

Why This Topic Matters

Fraud-and-abuse exposure can create significant compliance, payment, and audit risks for a practice. Understanding these general safeguards helps organizations strengthen internal controls and respond appropriately when billing or documentation concerns arise.

Article Sections

1. Always Collect Deductibles and Copays

   Discusses Medicare compliance concerns related to routine patient cost-sharing practices and documentation of collection efforts. The section also addresses general issues connected to billing before services are performed.

2. Use Billing Services Wisely

   Covers oversight of outside billing vendors, recordkeeping expectations, and maintaining control over practice-submitted information. It emphasizes accountability for claims-related processes handled on behalf of the practice.

3. Keep NPIs Private

   Focuses on protecting provider identifiers and maintaining responsibility for accurate billing workflows. The section also notes the importance of checking delegated coding activities.

4. Keep Pristine Documentation

   Addresses general documentation quality expectations, including legibility, signatures, dates, and record support for reported services.

5. Act Quickly If You Did Something Wrong

   Summarizes high-level response steps when a billing or relationship issue is discovered, including legal review, stopping problematic practices, assessing funds involved, and considering formal disclosure pathways.