- Kameron Gifford, CPC
On February 11, 2013 Departments
of Justice and Health and Human Services announced record-breaking recoveries of
4.2 billion in CY 2012. http://www.hhs.gov/news/press/2013pres/02/20130211a.html
This “joint effort
to combat healthcare fraud” does not appear to be going away anytime soon. In fact, I believe the only way that we can
stop the governments intrusion into healthcare is to create accountability within
the industry. How long do you think audits would continue if they revealed
compliant operating and billing practices? Without recoveries the funding would
There are seven things
that will destroy us: Wealth without work; Pleasure without conscience;
Knowledge without character; Religion without sacrifice; Politics without
principle; Science without humanity; Business without ethics.
- Mahatma Gandhi
If you practice medicine, run a hospital, or manage a practice, you are intimately aware
that even the best people can make mistakes. Have you ever spent days looking
for a missing chart or come across a critical lab that had been “misplaced”? Or
maybe you received a list of medical records to be audit by an insurance
company and 1 of the dictations has “disappeared” or better yet, the patient never
came in that day. Was this a malicious act by your front office staff or biller?
Probably not, but it is what you do at that exact moment of discovery that will
determine the potential of a negative outcome.
In my experiences it a combination of blunt honesty and a sincere desire
to “make it right” that yields the greatest possible outcomes. We are human and
mistakes are inevitable.
With increasing oversight and increasing expectations of due diligence,
all eyes will be on the healthcare industry. What can we do if we have received
a letter relating to an investigation or audit? What if we have recently
settled a claim of “upcoding or over-billing”?
Take actions to improve. Remember, everything happens for a reason. We often suffer through
misfortune before we can reach the high points in life. View this as an
opportunity to show the world your inner strength and resilience. Create a stronger corporate culture, invest in education, and continue to strive every
day to do something more than you did yesterday.
If you have not yet
been the target of an audit, prepare now, because you will be one day. Audit
yourselves just as the OIG, Medicare or Medicaid or a commercial payor might. Our best
offense is a great defense. Create transparent processes, encourage
conversations between your entire team, and get a second opinion. A fresh
perspective may be your most valuable resource.
- Mahatma Gandhi