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6 Ways to Avoid Unintentional Medicare Fraud

Greg Freeman, January 30, 2014

"People have been indicted for not providing supervision, because in the eyes of the state if you did not supervise properly, you did not provide the service," Dagli says. "They take a very strong line with these things."

3. Patient didn't pick up the medications. If you are not crediting back the medication that was not dispensed or picked up, this could be fraud. There must be a system in place to flag medications that were prescribed and billed for, but which the patient never received.

4. Billing clerk assumes doctor performed certain services. If he or she didn't, even if the doctor was supposed to, the billing could be fraudulent. This can be an easy mistake to make because physicians depend on their billing staff to understand some routine treatment and know that certain services are always provided in particular cases. That can ease the billing process, but it can lead to fraud if the clerk automatically charges for that treatment when, for whatever reason, it was not provided to that patient.

"This can turn into sloppy management if you're not careful," Dagli says. "We know that everyone wants to streamline the systems and depend on staff to know certain things without being told, but that's a slippery slope that can lead to bills being automatically generated when the doctor decided to change the treatment routine for some reason or just forgot to do something."

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