Compliance risk areas for physician medical practices
The following are identified compliance risk areas for physicians:
- soliciting, offering, or receiving a kickback, bribe or rebate;
- routine waiver of copays and deductibles, regardless of need;
- billing for services not rendered;
- double billing;
- billing for physician services rendered by non physicians/teaching physician requirements;
- medical necessity;
- misrepresenting diagnosis to justify services;
- completing certificates of medical necessity for patients not personally and professionally known by the physician;
- billing Medicare/Medicaid for investigation research, medications, and procedures without proper authorization; and
- billing for a non covered service as if covered.
Rarely do I find "intentional" compliance errors; most "unintentional" errors are the result of carelessness, a lack of monitoring, a lack of checks and balances, a lack of education, poor billing staff, etc. etc. etc.........you get the point. Just make sure this isn't happening within your physician medical practice.