Compliance risk areas for physician medical practices

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.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.