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Former Assistant U.S. Attorney

Steps to protect yourself from healthcare fraud allegations

On Behalf of | Apr 23, 2020 | Firm News

The government is cracking down on cases of healthcare fraud. As a healthcare provider, you know how arcane and complex healthcare regulations can be. Honest mistakes or sloppy record-keeping can result in serious criminal charges. The following are some of the steps you can take to help ensure your business remains on the right side of the law.

Create a compliance program to identify and prevent instances of fraud

Compliance programs are essential to preventing fraud. The Office of Inspector General of the Department of Health and Human Services has set forth some guidelines for creating a successful compliance program, including:

  • Developing written standards and policies
  • Implementing continuing education and providing resources to staff members
  • A process to address allegations of fraud

It is crucial to the success of any compliance program to perform regular effectiveness evaluations. The creation of a compliance program can help provide you with a solid defense against criminal fraud charges.

Review and improve your medical billing and coding processes

Many fraud charges stem from billing for services that were not rendered or for services that were not properly coded. This is where a mistake or poor record-keeping can land you in trouble. You should have a process in place to ensure proper coding and billing, backed up by documentation.

Be mindful of anti-kickback statutes

Referrals are a part of medical care. However, you must ensure that your referrals do not run afoul of anti-kickback statutes. It is easy to blur the lines between an honest referral and one involving a quid pro quo.

Remember to assert and protect your rights

If, despite your best efforts, you still find yourself charged with healthcare fraud, remember that you have rights. A skilled professional can help you assert your rights and defend against criminal allegations.