Fraud, Fines, and Prison Time: Healthcare in Michigan

Healthcare fraud is rampant in Michigan and the federal government is cracking down on healthcare practices.

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Recently, an Oakland County biller, Dawn Bentley, was ordered to pay $3,252,107 in restitution and sentenced to 50 months in prison.

Why?

Ms. Bently was convicted of mail fraud and of conspiracy to commit health care fraud, wire fraud, and mail fraud.

These convictions were passed down as Ms. Bentley knowingly submitted fraudulent bills on behalf of a physician, for services she knew were not rendered. The physician paid her 6% of the total billings from Medicare.

The case was investigated by the FBI and the U.S. Department of Health and Human Service Office of Inspector General (“HHS-OIG”).

How can you protect your practice from fraud and fines?

Make sure that you use internal and external audits to catch potential billing errors.

Train your staff on HIPAA and compliance with federal and state regulations, and on the potential sanctions.

Train on billing and coding, to make sure that physicians in your practice are not upcoding or billing for services not rendered.

Ensure that your practice has open lines of communication, so that physicians and billers feel free to communicate concerns.

Compliance is an ongoing process and compliance education should be ongoing at your practice.

In our next blog post, we will keep you informed of related issues.  To get this important information delivered directly to your mail box, click here to Subscribe.

Do you need help staying current and compliant with the latest laws, rules and regulations?  We can help. To contact us about your new government rules and regulations, your practice’s risk assessment, or about your other legal needs:  CLICK HERE.

P.S. If you or your patients are interested in consumer healthcare issues, check out myhealthspin.com.

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