It may not be enough to hire a professional billing and coding employee or service. Doctors are obligated to acknowledge on every claim form that the information submitted to the government for billing is correct. In meeting this obligation, Doctors hire billing and coding experts to ensure that the bills submitted properly apply the correct billing code to the treatments ordered for patients.
However. recent federal case law appears to require physicians, hospitals and medical professionals to know the legal requirements for the valid submission and collection of claims for medical services. Medical professionals who simply chose not to educate themselves may be found to have acted in deliberate ignorance or with reckless disregard and may thereby be liable under the False Claims Act. The submission of a Medicare claim by a provider is a certification that the provider has complied with the Medicare Act’s medical necessity definitions and complied with all relevant laws regarding submission of claims to the federal government. See our post at: https://schneiderfederallaw.com/false-claims-statements.html
To succeed on a False Claims Act case the government or the Qui Tam Plaintiff must prove: (1) a false or fraudulent claim; (2) which was presented or caused to be presented by the defendant to the United States for payment or approval; (3) with the knowledge that the claim was false. The damages assessed to the guilty defendant under the Act include liability for a civil penalty of not less than $5,000 and not more than $10,000, for each violation (claim) plus 3 times the amount of damages which the Government sustains because of the violation.
Please call us to learn more about how we can help defend you and your practice.