For some people, the attraction of medical work is job stability. For others, it may be a desire to help people. Still others look at medicine is a potentially lucrative career, as physicians can command competitive wages in many markets.
However, running your own practice can often be more expensive than you might have thought before you started working. In addition to repaying the cost of medical school, you have to cover the cost of other staff members’ wages, equipment and space expenses, and malpractice insurance. In order to generate enough income to cover all of those costs, you might decide to work with multiple different insurance companies or government insurance programs in order to treat as many patients as possible.
That may mean needing to accept lower rates of compensation, especially if you accept government insurance programs such as Medicaid or Medicare. Trying to maximize your income to support your staff and your practice may seem like a smart business move, but some of the tactics that you might take could constitute medical billing fraud and leave you at risk of criminal charges, financial consequences and possibly even the loss of your license.
There are many different kinds of medical billing fraud
Some forms of medical billing fraud are more obvious and unethical than others. For example, performing unnecessary procedures on patients in order to bill for them is unethical and could cause harm to your patients. Overtly billing for services you didn’t provide may also seem obvious and inappropriate.
You might engage in less overt forms of fraud, such as intentionally unbundling discounted services by billing for each individual component separately or mildly upgrading the procedure you performed when it comes to billing in order to charge more.
Those accused of billing fraud could wind up unable to practice medicine
The State Board of Medicine helps ensure that patients in Pennsylvania receive at least a minimum standard of care when they seek medical assistance by licensing and regulating those practicing medicine in the state.
Medical professionals accused of significant criminal activity, particularly criminal activity that relates to their profession, could find themselves summoned for a disciplinary hearing which could include consequences as significant as the loss of their license to practice medicine. Responding to the charges against you and to the summons of the board will be equally important in protecting yourself and your professional practice after someone alleges inappropriate billing practices.