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The Compliance Minute

 

In this month’s installment of “The Compliance Minute” we will focus on accurate billing.  How is this a potential compliance issue?  If an organization practices sketchy billing practices and or consistently charges or bills its customers inaccurately, not only does it make the organization look bad, but it could be construed as fraud.  Simply put, fraud is defined as a false representation of a material fact.  In our industry, fraud can take on different forms and varieties: false statements supporting claims for payment, misrepresentation of material facts, concealment of material facts, or the theft of benefit payments from a third party.

 

As a team member of Mission Point Healthcare Services, you are entrusted to always document the services and care you provide with integrity and honesty.  This means that if you provided 30 minutes of therapy, we do not bill Medicare or Medicaid for an hour.  This means if you code a residents ADL score as a “max assist”, that you actually provided that level of care. It can take on other forms, too.  Double billing for care and services, and submitting claims to Medicare or Medicaid for services that were not provided by the facility are all other ways fraud can manifest.

 

If you have reason to believe that anyone (including yourself) is engaging in false or inaccurate billing practices, you should immediately report this to your supervisor, the “We Care” compliance hotline, or the Corporate Compliance Officer.

 

For more information on our Corporate Compliance Plan and/or our policy on Accurate Billing, please speak with your Administrator or contact the Corporate Compliance Officer 248-940-5390, ext. 1023.

 

Emery Dumas, LNHA, CDP, CHC
MPHS Corporate Compliance Officer