12:00 AM CDT on Monday, June 23, 2008
By PAMELA YIP / The Dallas Morning News
If you don't have the energy to deal with high medical bills because you're seriously ill, don't panic. There are professionals who can help you.
A medical billing advocate will comb through your medical bill for errors that cost you more money than you should pay.
Nora Johnson, vice president and director of education and compliance at Medical Billing Advocates of America in Salem, Va., said there are duplicate charges "in almost every [inpatient] bill."
She's also seeing more errors in outpatient bills.
"It's increasing 1,000-fold," Ms. Johnson said.
Billing advocates typically charge a percentage – ranging from 25 percent to 50 percent – of the savings they get for you.
Some charge by the hour or a combination of hourly and percentage rates. It depends on the time required to work on your case.
When you hire a billing advocate, you typically will sign release forms authorizing your health care provider, insurance company and other relevant parties to discuss your case with the advocate.
Before hiring an advocate, ask about his or her background. The person should have experience in medical billing, health insurance or health care administration.
Make sure you feel comfortable with the advocate before hiring. Ask about the advocate's experience and the largest amount saved for a client on a medical bill.
To find a medical billing advocate, visit www.billadvocates.com or call 540-387-5870.
Showing posts with label Medical Billing Error. Show all posts
Showing posts with label Medical Billing Error. Show all posts
Dublin Doctor Defrauds Medicare, Medicaid, Gets Four Years Probation For Health Care Fraud
Source: rockbridgeweekly.com
Acting United States Attorney Julia C. Dudley announced today that Dr. Linda Sue Cheek, age 59, of Dublin, Virginia, was sentenced yesterday in United States District Court for the Western District of Virginia in Roanoke for defrauding Medicaid and Medicare.
“These taxpayer-funded health care programs are designed to allow our friends and neighbors who are in need of medical care, the opportunity to obtain it,” Acting United States Attorney Julia C. Dudley said today. “When physicians like Dr. Cheek take advantage of these programs in order to get rich, it is our job to hold them responsible for their actions.”
Cheek was sentenced to serve four years of probation for her role in a scheme to knowingly and willfully defraud the Medicaid and Medicare health care programs for her own personal, financial gain. In February Cheek pled guilty to one count of health care fraud, admitting that she had been stealing from the two programs from January 2002 to March 2006.
In addition, Cheek was ordered to pay a total of $24,210.37 in restitution to Medicare and Medicaid and will be required to serve 600 hours of community service in a non-medical field. As part of her sentencing, her license to practice medicine was also revoked.
The defendant, who was a licensed physician by the Commonwealth of Virginia, operated New River Medical Associates, Inc. located in Dublin, Virginia. The facility operated primarily as a pain management and alternative medicine practice.
Cheek previously admitted that between January 2002 and March 2006 she submitted a series of false Medicare and Medicaid claims relating to her medical practice, including the practice of billing Medicaid and Medicare for services she had not performed.
In addition, Cheek admitted to billing Medicaid for services she claimed to perform herself that were, in fact, performed by one or both of the two nurse practitioners employed by New River Medical Associates. Cheek admitted that during many of these procedures she was out of the office and, at times, out of the country.
Finally, Cheek admitted to billing Medicaid and Anthem Blue Cross Beneficiaries for individual treatments called “cleansing sessions,” an investigational service. These “cleansing sessions” were performed and billed as regular, individual office visits but were carried out in a group setting. Medicaid, Medicare and other insurance providers do not allow medical professionals to bill for group sessions.
This case was investigated for the United States Attorney’s Office, Western District of Virginia by the Virginia Attorney General’s Medicaid Fraud Control Unit, the Internal Revenue Service, the U.S. Department of Health and Human Services, Office of Inspector General, the Virginia State Police Drug Diversion Unit and the Financial Investigation Unit of Anthem Blue Cross Blue Shield.
Assistant United States Attorneys Patrick Hogeboom and Charlene Day prosecuted the case for the United States.
Acting United States Attorney Julia C. Dudley announced today that Dr. Linda Sue Cheek, age 59, of Dublin, Virginia, was sentenced yesterday in United States District Court for the Western District of Virginia in Roanoke for defrauding Medicaid and Medicare.
“These taxpayer-funded health care programs are designed to allow our friends and neighbors who are in need of medical care, the opportunity to obtain it,” Acting United States Attorney Julia C. Dudley said today. “When physicians like Dr. Cheek take advantage of these programs in order to get rich, it is our job to hold them responsible for their actions.”
Cheek was sentenced to serve four years of probation for her role in a scheme to knowingly and willfully defraud the Medicaid and Medicare health care programs for her own personal, financial gain. In February Cheek pled guilty to one count of health care fraud, admitting that she had been stealing from the two programs from January 2002 to March 2006.
In addition, Cheek was ordered to pay a total of $24,210.37 in restitution to Medicare and Medicaid and will be required to serve 600 hours of community service in a non-medical field. As part of her sentencing, her license to practice medicine was also revoked.
The defendant, who was a licensed physician by the Commonwealth of Virginia, operated New River Medical Associates, Inc. located in Dublin, Virginia. The facility operated primarily as a pain management and alternative medicine practice.
Cheek previously admitted that between January 2002 and March 2006 she submitted a series of false Medicare and Medicaid claims relating to her medical practice, including the practice of billing Medicaid and Medicare for services she had not performed.
In addition, Cheek admitted to billing Medicaid for services she claimed to perform herself that were, in fact, performed by one or both of the two nurse practitioners employed by New River Medical Associates. Cheek admitted that during many of these procedures she was out of the office and, at times, out of the country.
Finally, Cheek admitted to billing Medicaid and Anthem Blue Cross Beneficiaries for individual treatments called “cleansing sessions,” an investigational service. These “cleansing sessions” were performed and billed as regular, individual office visits but were carried out in a group setting. Medicaid, Medicare and other insurance providers do not allow medical professionals to bill for group sessions.
This case was investigated for the United States Attorney’s Office, Western District of Virginia by the Virginia Attorney General’s Medicaid Fraud Control Unit, the Internal Revenue Service, the U.S. Department of Health and Human Services, Office of Inspector General, the Virginia State Police Drug Diversion Unit and the Financial Investigation Unit of Anthem Blue Cross Blue Shield.
Assistant United States Attorneys Patrick Hogeboom and Charlene Day prosecuted the case for the United States.
Feds in Indy seek $789K from medical supplier
May 23, 2008. IndyStar.com
A lawsuit filed by the federal government in Indianapolis accuses a medical products supplier based in northeastern Illinois of falsely billing Medicare for $789,579 in medical equipment.
The government claims Criterion Medical Corp. of Braidwood, Ill. submitted 1,427 false claims between May 2002 and October 2007, billing the government for knee and calf replacement liners.
A government investigation determined those liners were not medically necessary and that Criterion acted recklessly.
The government seeks reimbursement and unspecified damages.
Attempts today to reach Criterion were unsuccessful.
Although the company has an active Web site, phone numbers listed for Criterion are disconnected.
The billings were for Medicare patients in Indiana.
Dealing with Medical Billing Errors
Submitted by Nicole Wilson on May 9, 2008 - 5:00pm
Medical billing errors may sound innocent; however, these so called mistakes may be just another way for either doctors or billing agencies to make some extra money. Filing false claims and double billing can be big trouble for the medical industry with the serious charge of fraud.
According to Medlaw.com a Michigan psychologist plead guilty for filing false claims with both insurance companies and Medicare. He was said to have filed $853,000 false claims.
Other doctors that commit this crime may double bill for procedures and doctor visits. They also will pad the bill with procedures they did not complete. The medical offices will defend that it is difficult to come up with the correct codes for appropriate billing to insurance and Medicare. It can also be difficult getting paid for honest claims that are not fraud they argue.
I was always under the impression that doctors were generally honest and that they mean well. I guess I wouldn’t have been so irked if it didn’t happen so often. My personal experience with billing errors has happened not once but five times in just the past couple of years. Since we have major medical and very little coverage we get to pay the majority of the bills. Doctor visits are not covered, so I always pay for the doctor visit up front.
The first time this happened was with a surgery for a lump that was removed. We paid the doctor visits with a credit card at the doctor’s office. A couple months later a bill for what we already paid for showed up in our mailbox. We talked with the accounting person in the office, and they were actually good about correcting this medical billing error.
The second time we had a medical billing error was when I had to go to registered dietician. They were so wonderful to have a pay up front before the doctor visit for the cash patients. They also took my insurance card, they insisted upon it, and I told them that my doctor visits are not covered. The service provided by the dietician was wonderful and helpful. But around 5 months later we receive a bill in the mailbox saying that we owed for the visits that we already paid for! What got tedious with this one was an intermediate medical billing company that didn’t answer their phone calls. I called the regular office, and they gave me the run around. Needless to say, I had to leave several messages on the billing offices machine to get anywhere. I finally got the problem straightened out, but both the doctor office and the billing office had no concern to fix the problem, unless they knew I was going to be calling them every single day for the rest of their lives. The problem did get resolved. But it really was annoying that I had to prove my innocence even though I paid for the visits up front.
The third time I encountered a medical billing error was at a different procedure for a biopsy. This time the insurance company gave a discount. They sent a statement for the allowed amount that the biopsy could be charged for and what part I was to pay. The office that did the biopsy sent the bill but it was over $200 when the allowed amount was only $40. I wrote a letter with the bill and sent a copy of the insurance paperwork and paid the correct amount. They never sent another bill after that. But I started to wonder how many people will pay the full price and never look at the other information sent by the insurance company.
The fourth time that I had a medical billing error was when I had to get an ultrasound done. This time the lab decided to pad the procedure with an additional ultrasound that they never did! I called the office up and had to explain that I did get the one ultrasound but not the other. The extra ultrasound that never happened was an additional amount of $280. I was happy that this time, they fixed the problem fairly quickly.
The fifth time that I have experienced this mysterious medical billing error was a bill that I had already paid for and have received another bill saying that they haven’t received payment. They cashed the check, and I have the copied check that I have mailed, faxed, and called them about. They have a medical billing agency too, and I first left a message but, no calls came back. So I faxed them and called them and got through to that person assigned to your bill. They assured me that they will not send the bill to collections and that it will take a bit of time to figure out. By now, after it being a regular thing these medical billing errors, I have lost my patients with the hours that I have to put into correcting them.
I haven’t had every single bill go this way. I will think twice about going back to those offices that I had these problems with in the first place. I don’t want to go through the headache again! If you have PPO you can shop around a little bit more than the dreadful HMO.
So the moral of the story is if I am just one individual that has encountered numerous medical billing errors, I would suspect that this is common practice and that there are a lot of individuals that are overpaying for their medical services. Since it is a fraudulent activity I would think that the medical billing offices would have absolutely no chance for medical billing errors.
Take your time and don’t be afraid to speak up if you do find a medical billing error. It is your hard earned money. I believe that doctors deserve what is fair and agreed upon and anything not completed or over billed is just wrong.
- by Nicole Wilson
Medical billing errors may sound innocent; however, these so called mistakes may be just another way for either doctors or billing agencies to make some extra money. Filing false claims and double billing can be big trouble for the medical industry with the serious charge of fraud.
According to Medlaw.com a Michigan psychologist plead guilty for filing false claims with both insurance companies and Medicare. He was said to have filed $853,000 false claims.
Other doctors that commit this crime may double bill for procedures and doctor visits. They also will pad the bill with procedures they did not complete. The medical offices will defend that it is difficult to come up with the correct codes for appropriate billing to insurance and Medicare. It can also be difficult getting paid for honest claims that are not fraud they argue.
I was always under the impression that doctors were generally honest and that they mean well. I guess I wouldn’t have been so irked if it didn’t happen so often. My personal experience with billing errors has happened not once but five times in just the past couple of years. Since we have major medical and very little coverage we get to pay the majority of the bills. Doctor visits are not covered, so I always pay for the doctor visit up front.
The first time this happened was with a surgery for a lump that was removed. We paid the doctor visits with a credit card at the doctor’s office. A couple months later a bill for what we already paid for showed up in our mailbox. We talked with the accounting person in the office, and they were actually good about correcting this medical billing error.
The second time we had a medical billing error was when I had to go to registered dietician. They were so wonderful to have a pay up front before the doctor visit for the cash patients. They also took my insurance card, they insisted upon it, and I told them that my doctor visits are not covered. The service provided by the dietician was wonderful and helpful. But around 5 months later we receive a bill in the mailbox saying that we owed for the visits that we already paid for! What got tedious with this one was an intermediate medical billing company that didn’t answer their phone calls. I called the regular office, and they gave me the run around. Needless to say, I had to leave several messages on the billing offices machine to get anywhere. I finally got the problem straightened out, but both the doctor office and the billing office had no concern to fix the problem, unless they knew I was going to be calling them every single day for the rest of their lives. The problem did get resolved. But it really was annoying that I had to prove my innocence even though I paid for the visits up front.
The third time I encountered a medical billing error was at a different procedure for a biopsy. This time the insurance company gave a discount. They sent a statement for the allowed amount that the biopsy could be charged for and what part I was to pay. The office that did the biopsy sent the bill but it was over $200 when the allowed amount was only $40. I wrote a letter with the bill and sent a copy of the insurance paperwork and paid the correct amount. They never sent another bill after that. But I started to wonder how many people will pay the full price and never look at the other information sent by the insurance company.
The fourth time that I had a medical billing error was when I had to get an ultrasound done. This time the lab decided to pad the procedure with an additional ultrasound that they never did! I called the office up and had to explain that I did get the one ultrasound but not the other. The extra ultrasound that never happened was an additional amount of $280. I was happy that this time, they fixed the problem fairly quickly.
The fifth time that I have experienced this mysterious medical billing error was a bill that I had already paid for and have received another bill saying that they haven’t received payment. They cashed the check, and I have the copied check that I have mailed, faxed, and called them about. They have a medical billing agency too, and I first left a message but, no calls came back. So I faxed them and called them and got through to that person assigned to your bill. They assured me that they will not send the bill to collections and that it will take a bit of time to figure out. By now, after it being a regular thing these medical billing errors, I have lost my patients with the hours that I have to put into correcting them.
I haven’t had every single bill go this way. I will think twice about going back to those offices that I had these problems with in the first place. I don’t want to go through the headache again! If you have PPO you can shop around a little bit more than the dreadful HMO.
So the moral of the story is if I am just one individual that has encountered numerous medical billing errors, I would suspect that this is common practice and that there are a lot of individuals that are overpaying for their medical services. Since it is a fraudulent activity I would think that the medical billing offices would have absolutely no chance for medical billing errors.
Take your time and don’t be afraid to speak up if you do find a medical billing error. It is your hard earned money. I believe that doctors deserve what is fair and agreed upon and anything not completed or over billed is just wrong.
- by Nicole Wilson
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