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Advice needed

  1. Unhappy Advice needed
    Medical Coding Books
    I have just been terminated for refusal to,what I strongly believe is, double billing insurance companies. Is there anyone out there who has had any experience with this?

  2. #2
    Dover Seacoast New Hampshire
    Quote Originally Posted by DawnMichille View Post
    I have just been terminated for refusal to,what I strongly believe is, double billing insurance companies. Is there anyone out there who has had any experience with this?
    I'm sorry you've been let go, regardless of the issue. I'm going to give you a couple of points of view. It really is up to you what you decide to do.

    If your refusal to double-bill in any way involved Medicare, you can contact your local payer; they have a tip line that allows you to report compliance issues anonymously. The OIG also has a number you can call to report non-compliance.

    If the double billing was related to commercial insurances, you certainly can report your concerns to them. Some payers take this more seriously than others, however.

    Do you have a compliance office at your previous employer? I cannot believe that a physician or hospital would terminate you for such a reason, in view of the strict compliance laws. If you were working for a billing company, I would report this to the client (the provider for whom you were asked to double-bill). I can't imagine they would be happy to hear that they were entrusting their billing to a company who engages in questionable billing practices. Remember, they are liable for what their billing company does.

    Here's my other thought, so please be forewarned. You're now considered a "disgruntled employee". Not everyone is going to take you seriously, unless you've clearly documented what, where, when, why and who. Take some time to get everything down on paper and make sure you have your facts straight before you speak to anyone. This will give you credibility during what could turn out to be a very stressful time. "Whistleblower laws" do allow you some legal protection, but depending on who is involved and how big this becomes, you could easily find yourself in the middle of a large fiasco, complete with lawyers, press and the govenment. What I'm saying is this: be very sure that you were asked to commit fraud before you report anything. I'm not trying to convince you to shut up, I'm just suggesting that you view this from a distance and make sure that you have all your facts straight before you act.

    Whatever you decide to do, good luck. It's a shame that you were put in this position, but it speaks well of your ethics that you are willing to report this.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

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