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Preventing Healthcare Fraud

Preventing Healthcare Fraud
Hendershot Cowart

Every year the health care industry loses billions of dollars due to health care fraud and abuse. Health care providers must be diligent in implementing processes to detect and prevent fraud from occurring in their organizations. Failing to do so can lead to extensive investigations that not only hurt their revenue but their reputation as well.

National and State Health Care Fraud Laws

Several laws on the national and state level exist in order to combat health care fraud. These laws keep providers accountable for committing unethical acts within their communities.

One predominant national law includes the False Claims Act, 31 USC Section 3279, which is a federal statute that covers fraud involving any government-funded contracts and programs. Through this act, liability is established when someone knowingly makes a false claim to the government for financial compensation. For a claim to be knowingly fraudulent, someone must know that the information is false, deliberately ignores the truth or falsifies the claim, or acts in reckless disregard for the truth or falsifies the information in the claim.

Texas also has several laws to help stop fraud. For example, one specifically deals with Medicaid programs, like the Texas Medicaid Fraud Prevention Act. The act essentially makes it illegal to file false documentation or claim in order to receive payment from the state government.

Common health care fraud claims include:

  • Making false statements

  • Falsifying records

  • Double-billing services

  • Submitting bills for services never performed

  • Or making any other false claim

How Health Care Providers Can Detect and Prevent Fraud

Health care providers can implement several precautions to help detect and prevent fraud and abuse from taking place.

Providers can prevent and detect health care fraud through several methods, including:

  • Staying up to date on all health care laws and regulations

  • Provide accurate billing practices to patients and insurers

  • Keep accurate and extensive records of all patient care delivered

  • Do not participate in referrals with the expectation of receiving compensation in return

  • Be transparent of any gifts obtained through medical drug and equipment companies

  • Disclose any conflicts of interests

  • Develop an effective compliance program

One of the most essential tasks health care providers must do to stop fraud from happening in their organization is to create and implement a strong compliance program. Not only does a compliance plan promote patient care and help increase communication among staff, but it also improves the business financially. Additionally, to be Medicare and Medicaid eligible, providers must have a compliance program in place.

Seek Guidance from the Industry Leaders in Health Care Law

While most organizations and providers operate ethically, they can unintentionally fail to comply with industry regulations. This leads to criminal and civil investigations that can negatively impact your business’s finances and reputation. To ensure you remain compliant with current regulations, our team of skilled health care law attorneys is here to assist.

Call us today at (713) 909-7323 to discuss what steps your organization can take to prevent and detect fraudulent activity in the future.

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