Proper Billing Operations Are the Best Defense Against Fraud Charges

The case of a Canton, MI urgent care provider charged with 22 counts of medical fraud should serve as a cautionary tale and a reminder that unethical (or even just plain sloppy) billing practices can land operators, office staff, and physicians in hot water—or even jail. The physician in the Michigan case stands accused of billing Medicaid and Blue Cross Blue Shield for services he didn’t provide, resulting in nine counts of Medicaid fraud, 12 counts of healthcare fraud, and one count of running a continuing criminal enterprise. He could face 20 years in prison if convicted. Local police were the first to investigate the charges, but have since turned their findings over to the state attorney general; Blue Cross Blue Shield fraud investigators have also assisted. The state says it will prosecute this and all cases where fraud is alleged aggressively. To avoid being involved in one of them, talk to your billing vendor to assure they’re well-versed in applicable laws both nationally and in your state—and once you’ve gotten their advice, be sure to be vigilant in following it, which includes assuring that your staff is trained on proper procedures.