Medicare fraud/abuse charges: 4 ways to protect your practice

May 1, 2015

What can urologists do to protect themselves from being accused of and charged with health care fraud and abuse? Urologist Jeffrey Kaufman, MD, and attorneys J.D. Thomas, Esq and Laura F. Laemmle-Weidenfeld, Esq provide these four suggestions.

Ms. Laemmle-WeidenfeldWhat can urologists do to protect themselves from being accused of and charged with health care fraud and abuse? Urologist Jeffrey Kaufman, MD, and attorneys J.D. Thomas, Esq and Laura F. Laemmle-Weidenfeld, Esq provide these four suggestions.

READ - Medicare/fraud abuse: Focus shifts to providers

First, practice high-quality medicine. “Adhere to the AUA guidelines when there’s a question. You don’t have to meet the guidelines, but when you meet the guidelines, it gives you a great measure of security,” Dr. Kaufman said. “When you go beyond the guidelines, just be sure to document the justification and be ready to support your argument that it’s medically necessary.”

Mr. ThomasBe up-to-date in regulations, coding, billing. Realize that if you’re approaching patient care in a way that’s different than what Medicare recommends, you could draw the attention of HHS, DOJ, Medicare, or a contractor through an outlier analysis. Outlier analyses flag billing patterns that stand out against the norm, according to Thomas.

The rules are always changing to some extent, according to Laemmle-Weidenfeld. New ICD-10 codes are one example.

“It’s not enough to learn them all and then coast along for the next 10 or 20 years. Somebody has to be tasked, within the practice group or their billing entity, of making sure that they’re up to date in what they’re doing,” she said.

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Dr. KaufmanEmbrace transparency. If you’re going to refer a patient to your own lithotripsy center, that’s fine. But inform that patient about your ownership and why you’re suggesting your center. Give the patient options and let the patient decide without consequence, according to Dr. Kaufman.

Don’t guess. If you’re questioning whether you are about to enter a gray zone in fraud and abuse, and you’re likely to do it more than once, consider getting legal advice, according to Dr. Kaufman.

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