Go to the back of the CMS1500 form and read the attestation that the provider is signing their name to EVERY time they file a claim.
"Any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may be guilty of a CRIMINAL (emphasis added by me) act punishable under law and may be subject to civil penalties. Under penalty of perjury, I declare that I have read the foregoing; that the facts alleged are true, to the best of my knowledge and belief; and that the treatment and services rendered were reasonable and necessary with repect to the bodily injury sustained."
That's a pretty darn strong statement they are signing their names to.
I also refer you to (as mentioned by several other posters) the False Claims Act. They address several problems, but pertinent to your situation: Services not rendered.
Then, say your provider gets red flagged, PER claim, they can be penalized at a minimum of $5,500 up to a maximum of $11,000. Plus, the provider could be liable for up to three times the amount unlawfully claimed.
Not to mention the added Civil Monetary Penalities and potentially being excluded from Medicare.
Doesn't sound like something anyone wants to get into.
Everyone wants to help the patient, I understand that. That's what we are in this business for. However, just because the "patient doesn't have wellness coverage and their deductible is very high so only charge 99212"
You are falsifying your claim to seek reimbursement from the government, that should really be from the patient. The patient needs to understand their plan and policy -- healthcare is an expense to them too for some services.
Hope that helps.