Coder Liability for physician fraud

m.j.kummer

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I read somewhere that if a coder knows that a provider refuses to change when they have been informed of improper coding, documentation, and NPP rules the coder either has to hot line the provider or quit the job to avoid possible prosecution. Can anyone tell me where I read that???? am I having a nightmare... I can't find the article again.
 

kbarbag

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I don't know that I read it anywhere, but my instructor put it this way--and I agree with her
If the Dr has been informed it is fraud, you have two choices, if he will not change, you report him for fraud and find another job, or you stay and become part of the fraud. If an audit is done you are just as guilty as the Dr.
 

member7

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I don't know that I read it anywhere, but my instructor put it this way--and I agree with her
If the Dr has been informed it is fraud, you have two choices, if he will not change, you report him for fraud and find another job, or you stay and become part of the fraud. If an audit is done you are just as guilty as the Dr.
It is true that if you're called to court, your credentials will be on the line. Lawyers love to cite oaths and code of ethics in fraud cases.
 

m.j.kummer

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Coder Liability question

I have heard and agree with all that you have said, I need to have it in writing for those that I am trying to educate. I live in the show-me state now and you really do have to show them. If anyone finds the documentation please let me know where. I appreciate all of your input.
 

tonniam

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Coder Liability

The information you are looking for can be found in the Federal Register. The easiest way to find the info is to go to the OIG website and then search for "The False Claims Act". The language is very legal, but it basically states that any/all party who KNOWINGLY submit fraudulent claims (not just the physician) may be prosecuted.
 

tonniam

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The information that you are looking for can be found in the Federal Register under the False Claims Act. The easiest way to pull up the documentation about this is to go to the OIG website and search "False Claims Act".
 

elane15

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Medicare recently published updated manuals which their Fraud and Abuse one was one of them.. You can pull it from their website

http://cms.hhs.gov/manuals

It completely explains the situations in which penalties would be implemented under the fraud and abuse guidelines and who would be responsible / accountable. The tips hotline number to call is 1-800-447-8477. If you have trouble locating it, I will be happy to forward it to you from my personal email..

elane15@comcast.net
 

raptcatt

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Coder liability

Look at the article in the Coding Edge magazine that someone else referred to. It lists the laws. I think the article actually starts on p. 22 but is on pgs. 22 & 23.

I have shown this article to my employer when the issue arose. I am glad that this article was written!

Best wishes!

Melissa
 
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