(Updated Nov. 2, 2021)
Health care providers rely on medical billing professionals to adhere to the law and to the highest standards of integrity and honesty. Medical billing errors cost practitioners time and money that could be better spent treating and caring for their patients.
The vast majority of medical billing specialists act ethically. Still, it’s wise to consider just how detrimental unethical medical billing practices are to the entire industry. This goes beyond an accidental code or a mistake being made – unless it was intentional.
Think about a patient who has to navigate the red tape of improperly or unethically applied medical billing codes. It’s not enough that these patients may have just emerged from a stress-inducing visit to the doctor or hospital. Now they have to jump through hoops in order to fight back against unfair or incorrect billing procedures, too?
Medical professionals, health insurance companies, and medical facilities work hard to identify fraudulent billing for medical procedures. Health care fraud costs money; worse, it can cost lives. How many sick and injured people have avoided an office visit because they fear they won’t be treated fairly.
Billing fraud hurts us all. Patients must be reassured that their best interests are kept in mind when a medical biller works on their submitted claim. For our regular blog readers, there are a few good online resources on dealing with situations involving medical billing errors. Wikihow has a good piece here, and AARP has additional information here.
Reporting Unethical Behavior in Healthcare
Luckily, the medical profession is largely self-regulating. In most cases, physicians who believe a colleague is incompetent or unethical have an obligation to report clinical authorities. They may also report an incident(s) to the state licensing board or state medical society if there’s an immediate threat to patients. A physician’s first step should be to protect patients’ health and safety.
But what if you, as a patient, believe your physician or health care professional is guilty of unethical conduct? If you feel you’ve been mistreated by a healthcare provider or facility, filing a complaint can either stop the poor treatment, improve the overall quality of care, or at least clear up any misunderstandings.
In Washington State, you can file a complaint by reaching out to the Washington State Department of Health. You can fill out an online form, call the Health Systems Quality Assurance (HSQA) customer service center at (360) 236-4700, or send an email to HSQA.csc.@doh.wa.gov.
There are no time limitations applied to these complaints, although reporting this behavior as soon as possible is recommended. If an investigation finds any malfeasance by the health care provider, the case will be brought before a panel of members from the DOH or commission for approval to levy discipline.
This could be in the form of fines, counseling, placing limitations on the practice, retraining, revoking a license, or more. If the fault lays with the facility itself, while no criminal or civil penalties will be handed down, it will need to correct any violations that break the law.
5 Unethical Medical Billing Practices
- Upcoding. This is a form of upcharging or overbilling. It occurs when a patient is billed a higher amount than is necessary for a specific service. From NerdWallet: “Upcoding charge: A hospital could inflate a patient’s (procedure) to (a higher value CPT code), leading to a higher medical bill. For example, you could have received the lowest level of emergency room services but be billed at the highest level. This is an illegal, fraudulent practice, and you should ask your health care provider to correct the charge immediately.”
- Duplicate charges. Related to No. 1 in that it is also a form of overbilling. As the name indicated, this is getting billed twice for the same procedure. If you’ve ever overlooked something in a medical bill or an explanation of benefits, you can see why this might be the go-to method of squeezing more money out of a patient.
- Phantom charges. This means a patient has been billed not for incorrect services but for services that were never actually rendered.
- Unbundling. Again from NerdWallet: “Unbundling … refers to the separation of charges that should have been billed under the same procedure code. This type of mistake can be tricky to identify unless you’re a certified medical bill coder, but you can reference the National Correct Coding Initiative by the Centers for Medicare and Medicaid Services if you suspect such a mistake on your bill.”
- Incorrect quantities. An unethical medical biller could charge a patient extra by falsely inflating the total amount of items or medications received by the patient.
MBA Medical Billing Services
Like you and your caregiving staff, the medical billing experts at MBA Medical want what’s best for your patients and your practice.
MBA Medical staffers are experienced and knowledgeable about every piece of the medical billing revenue cycle. They’re also proactive and prepared for the changes and updates in medical billing codes and best practices in the healthcare industry.
With our honest, hardworking, and ethical billing specialists on your side, you won’t ever have to worry about any of the five unethical medical billing practices listed below. Give us a call today, and let’s start a partnership that lasts a lifetime.