The following are identified compliance risk areas for physicians:
– Unbundling;
– soliciting, offering, or receiving a kickback, bribe or rebate;
– routine waiver of copays and deductibles, regardless of need;
– billing for services not rendered;
– upcoding;
– double billing;
– billing for physician services rendered by non physicians/teaching physician requirements;
– medical necessity;
– misrepresenting diagnosis to justify services;
– completing certificates of medical necessity for patients not personally and professionally known by the physician;
– billing Medicare/Medicaid for investigation research, medications, and procedures without proper authorization; and
– billing for a non covered service as if covered.
Rarely do I find "intentional" compliance errors; most "unintentional" errors are the result of carelessness, a lack of monitoring, a lack of checks and balances, a lack of education, poor billing staff, etc. etc. etc………you get the point. Just make sure this isn't happening within your physician medical practice.
