Health care is one of the most regulated industries in America. As doctors in private practice, a careful juggling act must occur between caring for patients, running a business, and ensuring legal compliance. The Philadelphia health care lawyers at Sidney L. Gold & Associates P.C. help physicians avoid discipline and administrative actions stemming from the following common legal mistakes.
Billing errors are some of the most common and easiest mistakes to make; but they can have serious consequences. Given the severity and regularity of the act, a billing issue may trigger audits or official investigations. In many cases, the failure is just an oversight, but auditors may not view it as such. CPT coding mistakes are a form of wrongful billing, whether intentional or not, and often trigger audits. If investigators find too many billing errors they may be inclined to believe them intentional and pursue formal fraud charges.
Unintentional violations of Stark Laws can also trigger investigations. Likewise, if there is any hint of inappropriate gifts and commissions involved, an investigation can lead to charges of violating anti-kickback statutes. Finally, insurance companies sometimes over pay. A physician failing to notice the overpayment and notify the carrier of the mistake may come under serious scrutiny.
Another area where a doctor may easily get in trouble is billing insurance companies for cosmetic procedures that are not medically necessary. While some procedures are necessary, insurance companies may suspect fraud, especially if such charges occur often or with regularity.
Falsification of records related to audits and investigations, especially during malpractice suits are another area where a physician can land in deep legal waters. Although it may be tempting to protect oneself from damages resulting from incidental malpractice, a conviction for doing so comes with harsh penalties including loss of license and imprisonment.
A final fraud-related mistake involves a practice that is not illegal, but can trigger audits: Treating too many car accident victims. This is because insurance companies may get the impression that someone is involved in improper solicitation, phony diagnoses, and unnecessary treatments.
Communication is important in any business, but especially so in the medical field. In the office, a compliance plan can help personnel understand how to protect the practice from costly mistakes. Yet, to be effective, the plan must be communicated and understood by every staff member.
Related to this, a physician may confide in a staff member or close friend after a mistake has been made. This is an even bigger mistake. Errors that may be construed as fraud most certainly will should investigators start probing. A confidant may not even understand the ramifications of seemingly mundane statements made at such a time.
Philadelphia Health Care Lawyers at Sidney L. Gold & Associates P.C. Help Doctors Avoid Costly Legal Mistakes
The best way to avoid making costly mistakes is to consult with a health care lawyer who understands the medical field. The Philadelphia health care lawyers at Sidney L. Gold & Associates P.C. can help develop a sound compliance plan for prevention. Complete our online contact form or call 215-569-1999 to arrange a confidential consultation in our Philadelphia office.