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Possible fraud report

  1. #1
    Exclamation Possible fraud report
    Medical Coding Books
    I need some direction on where to go with an issue I witnessed at a prior job. I was forced to quit a job I was at last year around this time due to harsh and manipulating circumstances where my employers had tried to force us to upcode visits for higher reimbursements. When told that if I did not comply with what they were requesting, even though the documentation did not support the levels they were wanting us to bill, it would be considered insubordination and certain aspects of my job that I had earned would be taken away from me (forcing more hours, taking away the option of working from home when I lived 4 hours from the office I worked for and pretty much stating that they would make my job miserable for me if I refused to code to the specifications they demanded). And note, these demands came from the owners of the clinics I worked for who have no history in the medical field, were just the business owners of the clinic and out to make the most money possible despite what the documentation supported. I quit that job immediately, refusing to upcode ANY of the visits as they had wanted and, after being unemployed for close to 8 months, have finally found another coding position. My question is, what steps do I need to take to report these former employers? I have emails from them telling me upcode visits, as well as documentation showing that the doctor's notes did not support the documentation that we were being told to code for. I chose not to pursue the issue at that time because my focus was on finding a new job and, to be honest, was a little weary of my former employers and the affects it might have on my job search if I brought light to the subject at that time. Any help or advice on where to go with this would be greatly appreciated!

  2. #2
    Baton Rouge
    The place to go is the OIG (Office of Inspector General) website..

    Right side of page is box that says "Report Fraud"

    I've never had to use it, so not sure how easy it is, or what kind of info they ask for, but I went to a Compliance Session they did earlier this year. The situation you described sounds like exactly the kind of things they look for--people who are knowlingly fraudulently billing out for more than they should. You can subscribe to their emails and get reports of all the criminals they catch, it is AMAZING!!

    Hope this helps, and good for you for standing up for what you know is right!!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  3. Thumbs up
    Hi -

    I'm new - just joined today. Re your situation - you may want to consult an attorney specializing in Qui Tam litigation - aka "whistle- blower" law suit.

    If your previous employer was overbilling Medicare/Medicaid and you are the one responsible for bring it to light - you are entitled to as much as 25% of any $ recovery.

    Good luck!

    BTW - I am an RN but want to learn more about coding.............

  4. #4
    Thanks for the info guys!!

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