Healthcare Compliance Tips – Benefits & Resources
Healthcare Compliance Tips – Fraud
Review and reflect on the OIG’s thoughts about the difference between “erroneous” and “fraudulent” claims.
In this tip, we want to provide you all the OIG disclaimer.
The OIG wants you to know there is a difference between “erroneous” and” fraudulent” claims, in which they emphasize:
#1: The intent is not to discredit providers.
Some providers feel the OIG is against them and place unnecessary rules on practices. This is not the goal of the OIG, and they want to remind physician practices that innocent billing errors will not subject the practice to civil penalties or jail. They believe that most physicians are ethical and provide high quality care and proper claim submission.
#2: Under the law, physicians are not subject to criminal, civil, or administrative penalties for innocent errors.
As stated above, the OIG is aware that innocent errors will not subject the practice to civil penalties or jail. However, practices should still be aware of the criminal, civil, and administrative penalties and keep their team informed.
#3: Even ethical physicians make billing mistakes and errors unintentionally.
The OIG reminds physicians that if they discover billing errors, mistakes, or negligence, they should return the money back immediately. This will also show the government that you are making good faith efforts to protect the system.
#4: Innocent billing errors drain Federal healthcare programs.
The OIG sees this area as a chance for everyone to work cooperatively to reduce the overall error rate. The best way to do this is to ensure a compliance program is in place and that all staff are aware of their role in the process.
In the next few tips, we will discuss fraud, abuse, and laws. Click the arrow button below to see the next tip.
**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties. Research, modify, and tailor the advice to fit your specialty.