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patient attempts at fraud

  1. Default patient attempts at fraud
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    I have an elderly patient, on Medicare, who was in the office for a covered visit. We are a non-participating office, so the patient paid at the time of service, and will be reimbursed by Medicare. 2 weeks later she contacts the office saying she forgot that she had hurt herself on a motorized shopping cart at Walmart and wanted to know the "full" charge for the service so that Walmart could pay her. Comes down to she wanted Medicare to reimburse her for the information we had, and Walmart for the injury she claims she had, but that we have no record of, both for the same service. Obviously I want to record this incident, but where can I record it, that the patient does not get the opportunity to see it in her record and request a correction.

  2. #2
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    Quote Originally Posted by kvyrostek View Post
    I have an elderly patient, on Medicare, who was in the office for a covered visit. We are a non-participating office, so the patient paid at the time of service, and will be reimbursed by Medicare. 2 weeks later she contacts the office saying she forgot that she had hurt herself on a motorized shopping cart at Walmart and wanted to know the "full" charge for the service so that Walmart could pay her. Comes down to she wanted Medicare to reimburse her for the information we had, and Walmart for the injury she claims she had, but that we have no record of, both for the same service. Obviously I want to record this incident, but where can I record it, that the patient does not get the opportunity to see it in her record and request a correction.
    She can request a correction all she wants; she's not entitled to it. I don't see WalMart reimbursing someone without evidence supporting their claim, but if they do, that's their business. If she had a legitimate reason to see the doctor for the visit that Medicare reimbursed her for, then nothing about her encounter was 'fraudulent', per se. Make sure that your records are appropriately documented; it sounds like either she or WalMart may be requesting them in the future for some kind of litigation.

    You could kindly inform the patient that Wal-Mart has no obligation to pay for the services provided on the date in question, since your provider didn't evaluate or treat any injury. Perhaps reminding her that she can't prove her story, will be enough to keep her from getting your clinic into the middle of her shenanigans, in the future.

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