Insurance fraud networks affecting Florida healthcare, Physicians turn to
Medicalbillersandcoders.com for ethical and knowledgeable billers
WILMINGTON, Delaware, June 6, 2011 - The level at which healthcare insurance fraud operates in
Florida has shocked the National Health Care Anti-Fraud Association and The Department of Financial
Services, a division of Insurance Fraud, that investigates frauds for all types of insurance. The
intensity with which the frauds are planned has alarmed the investigators and given them enough
reason to investigate just about any clinic's claims.
Physicians in Florida have paid Medicare beneficiaries to sign papers for the treatment that
was not administered and use their Medicare numbers to bill Medicare
Physicians support up-coding and un-bundling mostly for expensive drug infusion treatments
for blood disorders
Falsify medical records to show severe symptoms
Hire specialized billing companies to bill Medicare
Bill for deceased doctor
Bill for doctor not available at PoS to Medicare
A consequence for physicians with such dubious intentions of course has been a sentence of ten (10)
years and financial penalty depending on the level of fraud.
National Health Care Anti-Fraud Association estimates that nearly $51 billion that is approximately 3%
of the healthcare industry’s expenditure in the United States is due to fraudulent activities. However,
it is difficult to gauge the extent of fraud but it is estimated that annually $115 billion is drained out of
Shocking it is, but medical fraud is highly prevalent in Florida; physicians gain financially and most
patients feel they are not affected as insurance takes care of the expenses even if it is fraudulent.
Unfortunately they do not realize that because of such practices insurance companies hike premiums
that increase the cost of healthcare.
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There is also a certain section of physicians who believe in billing only for the services provided and at
appropriate cost ethically, but these physicians are unaware of the billing and coding practices. Such
physician practices are dependent on billers and coders who may or may not fully understand the
implications of incorrect or fraudulent billing.
Incorrect or fraudulent practices over a period of time can land a physician's practice under the
scanner of Recovery Audit Contractor (RACs). Suspicious claims are submitted to the 'special
investigative units', or SIUs, for further investigation. These units generally comprise experienced
claims adjusters with special training in investigating fraudulent claims. These investigators are
experts in cracking patterns of fraudulent claims, and look for evidence of falsification of any kind.
RAC reviews the last three years of provider claims with the help of proprietary software to identify
potential payment errors in duplicate payments, mistakes of fiscal intermediaries', medical necessity,
Unintentional errors in billing and coding should not make you liable to these audits and hamper the
credibility of your practice. Experts at Medicalbillersandcoders.com have been investigating these
audits closely in Florida and have found that the main reason for Insurance Fraud allegations on a
clinic is when the administration is handled by novices or non-certified billers. The negligence and lack
of a forum to discuss issues such as unbundling, using more expensive codes, uncertainty in the use
of modifiers, and adding referrals appropriately can easily be sorted out with a network of
Medicalbillersandcoders.com, the largest consortium of Medical Billers and Coders is looking to combat
ignorance and fix insurance fraud indicators, though the observations started from Florida but its
awareness and solutions are being implemented across 50 states where the consortium extends its
membership. Physicians currently being assisted by Medicalbillersandcoders.com are also appreciating
the efforts of the association to educate and train billers against unintentional fraud.
Medicalbillersandcoders.com is the largest Consortium of Medical Billers and Coders, come together to
service providers with their specialized needs across End to End Revenue Cycle Management, Medical
Coding and Denial and Resubmission Management. With a presence across all 50 states and having
expert resource servicing all specialties, this consortium is all set to revolutionize the process of
locating Medical Billers and Coders.
Prerna Gupta, Media Relations
108 West, 13th street,
Wilmington, DE 19801
Tel : 888-357-3226
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