Health care fraud can lead to loss of a license

On Behalf of | Jan 5, 2023 | Professional License Issues |

Medical professionals, including doctors, chiropractors, and dentists, have a lot of duties to perform each day. Those who are in a private practice will have to handle things related to billing and medical coding. They may have someone handle this for them, but the onus may still fall on them to ensure it’s handled properly.

There are several billing issues that can lead to legal troubles for a person who holds a professional license. The easiest way to avoid problems is to provide an accurate diagnosis and appropriate medical care to each patient. You should bill out only for services actually rendered without inflating anything about it.

What are some billing issues that might lead to issues?

One of the more common billing issues that occur is when a medical professional falsifies a certificate of medical necessity so they can bill out for a service the patient doesn’t need. This sometimes occurs in conjunction with that person mispresenting a patient’s medical condition or the severity of it. Insurance companies base the suitability of many treatments and testing on the condition the doctor diagnoses a patient with, so misrepresenting the condition is a serious matter.

Another common issue occurs when the medical professional bills out individually for services that should have been part of a combined fee. For example, this sometimes involves a physician billing for an office visit with an examination and then charging another office visit fee to draw bloodwork from the patient during that same visit.

Anyone who’s accused of health care fraud should ensure they understand their options for addressing the matter. You could lose your professional license, so it’s best to consider that fact when you’re making your defense strategy.