Announcement

Collapse
No announcement yet.

is this fraud? Arizona

Collapse
This topic is closed.
X
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • is this fraud? Arizona

    Arizona outpatient clinic


    Hello.


    A new policy at work requires radiology techs to perform imaging in excess of what the RX requests. If the patient states he/she thinks he/she MIGHT have had a fx in the past (not documented by a licensed provider), we are told to perform more imaging which consequently changes the billing code from the code on the RX. Obviously this is done to bolster revenue.

    Most of the patients who require this type of imaging are on medicare/medicaid. Is this fraud? I am worried this could be a lawsuit in the waiting or at least a reason to protect my license.

    Thank you so much in advance.
    Last edited by Nepenthean; 03-17-2015, 06:09 PM.

  • #2
    No this is not fraud, as the tests being billed are actually being performed and it is being done in order to provide better and more comprehensive care to the patient. Fraud would be if you were billing for the more comprehensive tests but not actually doing them.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

    Comment


    • #3
      Originally posted by ElleMD View Post
      No this is not fraud, as the tests being billed are actually being performed and it is being done in order to provide better and more comprehensive care to the patient. Fraud would be if you were billing for the more comprehensive tests but not actually doing them.

      Thank you for the prompt reply.

      I spoke with a state regulator who said this action was illegal. This person said I should call the US Dept of Health and Human Services. This person also said if I could obtain specifics the regulatory agency would make an unannounced visit and begin an audit.

      Comment


      • #4
        Ok then - contact them & let them investigate re anything illegal being done.
        Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

        Live in peace with animals. Animals bring love to our hearts and warmth to our souls.

        Comment


        • #5
          This is definitely illegal under federal healthcare laws and regs (promulgated by CMS and HHS) and most likely under the state's law.

          The investigative and enforcement authority for cases like this is the office of Inspector General (OIG) of the US Dept of Health & Human Services.
          Performing and billing for diagnostic tests that were not prescribed is "fraud", but the term used in "false claim" (really another word for healthcare fraud).

          Comment

          Working...
          X