I'm in my first coding/billing job. Unfortunately, little alarms kept going on in my head about the way they did things but I couldn't quite put my finger on what was going on. Last Friday, I figured it out. This week, I verified that it was happening. Basically...a doctor can't be in two locations seeing patients in both at the same time. The issue seems to be being done on purpose, and it's causing payers to pay us more...which it seems those involved know and that's why they do it.
That's a skimmed down version of it, there is more unfortunately.
What do I do? I need to call the fraud line for sure. How and when do I quit my job...basically, should I just call them and say "I'm sorry I can't come in any longer" and leave it at that? I don't want my name attached to anything involving this! Do you need a lawyer to report this type of thing?
It's my first job out of college in this field...and I'm pretty upset.
Whoa, now...as it's been mentioned, be careful before throwing around the 5-letter "F-bomb". You could be mistaken about what you're witnessing (remember, you ARE new, and although this field is heavily regulated, and some of the regulations are clear, there are a LOT of exceptions to the rules that you may not be aware of; the laws are very complex, and often require legal analysis by an attorney to interpret accurately). Or, you could be absolutely correct, and are merely witnessing an innocent mistake from lack of knowledge. I'd speak up and ask there, first, but in the most tactful, and non-accusatory manner possible - ask with a 'curious-mind', how it's possible that things are being done the way that they are. If you have knowledge of a specific rule that being broken, ask how the arrangement conforms to the law. As long as you're respectful and humble about it, you shouldn't face any backlash.
If you do, it may be because there really is some impropriety going on - at that point, you'd have a legitimate cause for concern, so reporting to the authorities would be justifiable. IF (and only if) you are certain that it's intentional fraud (which will probably be because you are retaliated against in some manner for innocently bringing up the subject), a call to the OIG may be warranted. There are laws in place to protect whistleblowers from retaliation, and to reward the reporting of legitimate fraud to the government. Keep in mind, though, you can only report that to them, if government payers are involved. Otherwise, it's a breach of contract issue for the commercial payers to handle.
Tread lightly - you're in uncharted territory, and it can be a dangerous place to be. You don't want to lose a good job, or potentially smear someone's good name, over a simple misunderstanding.