Wiki Whistleblower ?

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gr8gal61

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I no longer work for this particular doctor however there has been some shady billing practices. I was never the biller although I am a CPC. Is there an agency to report some of this upcoding? procedures billed yet not performed and not credited when brought to the biller & owners attention? Double billing for "supervision" of a CRNA when the CRNA was NEVER supervised? Too many issues to mention and with all insurance companies including government. In addition, waiving deductibles when he has an in network facility but chose to use his out of network facility and non collection of copays when he is contracted???

My most important question is who would be at fault? I knew of some while working there as I was doing dome of the collections and I would bring it to his attention and I would show him requested recoupments and show him the reason due to the previous biller yet he would just shrug me off. Billing a urine test to work comp using 80104 when all the patient did was urinate in a cup and charge $1470.00. The billers mentality was "well we are getting paid for it"....and no she was not certified. uuuuuuggggghhhh
 
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Yikes! Thank your lucky stars you do not work for this provider anymore!!!

You could start with the district attorney for the county where the provider is located. They may have an online form to report work comp fraud, and they may handle private insurance fraud as well.

You can also contact the fraud department of the insurance carriers involved - I have reported provider fraud as a member, and the response I received from my insurance carrier was immediate - they went after the provider and requested medical records, and when the service was not substantiated, they recouped the payment made in error. The more detail you can provide about the fraud, the more likely they are to investigate and take appropriate action.

You can also contact the Medical Board or licensing agency of physicians in your state. I have no experience with this, but it may be worth looking at.

If federal funds are involved (ie Medicare), contact the Office of the Inspector General.

You may want to Google "insurance fraud attorney" and see if there is a law firm in your area which specializes in insurance fraud.

Good luck!
 
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