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Under-billing: A great way to be inefficient and go to jail?
Although I am unaware of an actual case of someone going to prison for under-
billing, here’s my opinion on how it could work:
Clinic A
Urologist Frank – Dr. Frank is an all-around good guy, sees patients, and bills appro-
priately for his new patient visit and its inclusive preoperative counseling. Any time he
books a laser surgery of the prostate; he appropriately bills new patient level 4 maybe
even level 5 if the surgery is complex (i.e., higher rate of complications – that folks are
foreshadowing). Frank charges the patient and insurance appropriately to the level
earned.
Clinic B
Urologist Beans – Dr. Beans is not that ethical. He hangs his shingle and invites
patients and sees them for free regardless of appropriate counseling. No charge but
books a surgery. Do not pass go, do not collect $200 – that my friends is a monopoly.
Inappropriately under-billing to increase surgical volume (ultimately where the higher
payment comes from) seems to be an instance where the Feds may get interested.
If you don’t want the Feds to get interested (9/10 MDs agree this is a good thing),
remember the story of Dr. Frank and Beans.
Overbilling: Excellent Strategies to Earn Prison Time
Here it is, the fear of quality alone time that ultimately prevents people from billing
appropriately. Plain and simple, it is ignorance of what the billing rules actually are
that is the problem. If you know the rules cold, you won’t worry about prison
(instead you can focus on plane crashes, spiders, and public speaking) and will bill
with confidence. Later on in this chapter, I will attempt to distill down the tomes of
rules to a few key concepts. For now, I’d like to list some great ways to get behind
bars quickly and list the most common mistakes I have encountered:
- Billing for patient visits when you are actually on the golf course (or in bed
asleep). Unless you have some fancy telemedicine apparatus in your golf cart or
a futuristic state-of-the-art foam pillow, this is definitely a no-no. It goes without
saying you shouldn’t bill for clinic patients or operations in which you weren’t
actually available (I guess I said it). Same thing with attesting notes written by
others (NPs, residents, etc.). The phrase “I have seen and examined the patient
and agree with the above findings” does actually mean you saw the patient.
Remember, residents are paid by the government for their efforts. If you bill for
a procedure or consult in which you are not present, that constitutes double bill-
ing. Imagine a scenario where you bill for an unattended procedure in the ER
that ultimately has a complication (probably more likely since you weren’t
there), and the case goes to trial, and you are called as a witness. Not only will
the plaintiff likely win but you will be on the hook for fraud as well – not a good
T.S. Köhler