Health Care Billing Errors and Fraud Reporting Health Care Fraud
Health Care Billing Errors and Fraud - Reporting Health Care Fraud
— Receive access to exclusive information, benefits and discounts. How billing fraud happens Billing fraud happens when health care providers file claims, knowing they are not correct. When they manipulate the coding system to their advantage, we all pay as taxpayers and premium payers. This can happen several ways. Upcoding: The doctor or other health care provider provides a service, but lists a billing code for a more complicated or lengthy procedure that pays more. For example, a brief office visit could be coded as an extensive visit. Group psychotherapy could be billed as if it were an individual session. Routine medical transportation could be coded as emergency life support transportation. A cold could be coded as pneumonia. Tests done by technicians could be coded as being done by physicians. By using codes for more serious procedures with higher rates of payment, providers can significantly increase how much they are paid. Unbundling: Some codes are meant to include a group of procedures commonly done together, such as cleaning a wound, stitching it and applying a dressing. Using three separate codes when there is one code for the procedure is called unbundling. It is illegal, but it can increase profits. Double billing: This happens when the same bill is submitted multiple times when the procedure was performed only once. What you can do If you think that your provider is not billing accurately, you can take several steps:
Always review your or health insurance for errors or mistakes. Use our to understand what’s in your summary notice.
Check past MSNs or EOBs to see whether there's a pattern of billing issues.
Contact the provider. It could be an error that your provider will correct, or he or she may explain why the coding is correct.
If you have Medicare and need help, you can contact your local (SMP). Trained SMP volunteers take complaints about potential health care fraud, investigate them and then refer them to the proper agency or official. Find your local SMP If the provider cannot resolve your billing concerns, report it.
Where to report If you have Medicare, you can report questionable billing practices to .
Phone: 1-800-633-4117 (1-800-MEDICARE)
TTY: 1-877-486-2049
Report questionable billing practices to your insurance company’s antifraud department. You should find a number to report fraud on your insurance Explanation of Benefits (EOB).
If you are on Medicaid, you should report your concerns to the State Medical Assistance Office.
Military personnel and veterans can report to .
You may also want to contact your .
Also of interest:
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Health Care Billing Errors and Fraud
Beware of health care providers who file false claims
Each procedure that your doctor or other health care provider performs has a billing code. This code is called the or Current Procedural Terminology. Providers use these codes when they submit claims to insurance companies or The code determines how much your provider will be paid. Because there are thousands of billing codes, mistakes can happen. These billing errors can be fixed if you call the mistake to the attention of the provider. By changing the codes, providers can get paid differing amounts of money. When providers use the correct codes for the procedures actually done, they get paid what they are due.Related
— Receive access to exclusive information, benefits and discounts. How billing fraud happens Billing fraud happens when health care providers file claims, knowing they are not correct. When they manipulate the coding system to their advantage, we all pay as taxpayers and premium payers. This can happen several ways. Upcoding: The doctor or other health care provider provides a service, but lists a billing code for a more complicated or lengthy procedure that pays more. For example, a brief office visit could be coded as an extensive visit. Group psychotherapy could be billed as if it were an individual session. Routine medical transportation could be coded as emergency life support transportation. A cold could be coded as pneumonia. Tests done by technicians could be coded as being done by physicians. By using codes for more serious procedures with higher rates of payment, providers can significantly increase how much they are paid. Unbundling: Some codes are meant to include a group of procedures commonly done together, such as cleaning a wound, stitching it and applying a dressing. Using three separate codes when there is one code for the procedure is called unbundling. It is illegal, but it can increase profits. Double billing: This happens when the same bill is submitted multiple times when the procedure was performed only once. What you can do If you think that your provider is not billing accurately, you can take several steps:
Always review your or health insurance for errors or mistakes. Use our to understand what’s in your summary notice.
Check past MSNs or EOBs to see whether there's a pattern of billing issues.
Contact the provider. It could be an error that your provider will correct, or he or she may explain why the coding is correct.
If you have Medicare and need help, you can contact your local (SMP). Trained SMP volunteers take complaints about potential health care fraud, investigate them and then refer them to the proper agency or official. Find your local SMP If the provider cannot resolve your billing concerns, report it.
Where to report If you have Medicare, you can report questionable billing practices to .
Phone: 1-800-633-4117 (1-800-MEDICARE)
TTY: 1-877-486-2049
Report questionable billing practices to your insurance company’s antifraud department. You should find a number to report fraud on your insurance Explanation of Benefits (EOB).
If you are on Medicaid, you should report your concerns to the State Medical Assistance Office.
Military personnel and veterans can report to .
You may also want to contact your .
Also of interest:
Cancel You are leaving AARP.org and going to the website of our trusted provider. The provider’s terms, conditions and policies apply. Please return to AARP.org to learn more about other benefits. Your email address is now confirmed. You'll start receiving the latest news, benefits, events, and programs related to AARP's mission to empower people to choose how they live as they age. You can also by updating your account at anytime. You will be asked to register or log in. Cancel Offer Details Disclosures