Fraud is nothing new, but that doesn’t mean it never changes. In fact, FierceHealthPayer recently reported on several fraud trends everyone in healthcare should all be alert to. The trends come from a speech given to the National Health Care Anti-Fraud Association by Jennifer Trussell, special advisor with the Office of Investigations at the Office of the Inspector General.
- EHR-related fraud. As EHR systems become more prevalent, there are increasing issues with fraud related to auto-population. Trussell notes that some systems allow auto-population to check or uncheck boxes related to what the clinician did to make a diagnosis. Because some software doesn’t include audit trails, it’s impossible to tell who checked/unchecked the box.
- ACA-related fraud. Trussell says fraud investigators must be vigilant about copycat HealthCare.gov sites and possible medical identity theft from those sites.
- Test-related fraud. There are two potential fraud areas here. One is expensive genetic tests that aren’t required for diagnosis. The other is testing companies targeting outside the clinical area (e.g., signing people up at shopping malls).
- Sleep-study fraud. Trussell says Medicare Part B medical billing for these services rose 40% in the last five years and warns healthcare companies to pay close attention to those claims.
- Medicare Part B schemes. Emerging trends include heart stents that are medically unnecessary and cosmetic procedures billed as precancerous lesions.
As private medical practices transition to medical billing software, they must be cognizant of the the latest fraud schemes and be sure the software they select aligns with rigorous medical billing processes to avoid unnecessary risk.
Last Updated on January 14, 2014