Wiki Legal vs ethical dilemma

[coderica2011]

Is a billing co legally obligated due to contract with doctor to submit charges to ins co's (esp. Medicare) even though they are aware that the doctor is committing fraud & is on "payment hold" because of an oig audit?

 

[mitchellde]

You are submitted claims that you know are fraudulent?? Even if you are under contract you cannot submit claims that you know are incorrect, your choices are send it back for revision, refuse to submit, or correct it before submission.

 

[Peter Davidyock]

How long has the billing company been a part of this?
You may want to start looking for another job.

 

[donnajrichmond]

OIG has a Compliance Guidance document for 3rd party billing companies.
In part, it says: "If the billing company finds evidence
of misconduct (e.g., inaccurate claim
submission) on the part of the provider
that they service, the billing company
should refrain from the submission of
questionable claims and notify the
provider in writing within thirty (30)
days of such a determination. This
notification should include all claim
specific information and the rationale
for such a determination.
If the billing company discovers
credible evidence of the provider's
continued misconduct or flagrant
fraudulent or abusive conduct, the billing company should: (1) Refrain
from submitting any false or
inappropriate claims; (2) terminate the
contract; and/or (3) report the
misconduct to the appropriate Federal
and State authorities within a
reasonable time, but not more than sixty
(60) days after determining that there is
credible evidence of a violation.