If you work in the billing department or transcribe physician notes as part of your job, it’s possible that your employer might eventually come to you and ask you to change something before you file the claim or finalize the record of a visit.
Occasional changes and mistakes do happen, but if you notice habitual correction requests or if your employer asks you to take certain liberties with the billing or records process, that could be a major warning sign of medical billing fraud at your place of employment.
If you suspect insurance fraud, you have an obligation to report those suspicions. Failing to take action could leave you in a vulnerable position if the federal government investigates and prosecutes your employer or their medical practice.
Participation in fraud does not require financial gain
At first glance, a scenario where your employer manipulates records or billing claims in order to make more money may seem like an issue that hardly affects you. After all, your job is just to submit those claims on behalf of the company. If your employer wants to play hard and fast with the rules, you might assume they are the one assuming all of the risks.
However, you could also wind up implicated in a conspiracy to commit fraud. Provided that you understood that there was a pattern of behavior and that what they did was likely a violation of the law, ignoring it could make you an accessory to the crime. Watch out for unbundling, charges for services not rendered, or changing the medical care from one treatment to another as possible red flags for billing fraud.
Protect yourself from fraud allegations when your employer breaks the law
It is possible that you may have unknowingly submitted claims associated with fraudulent billing practices, possibly for many years. For some people, the first time they realize that their employer had questionable billing practices is when they found themselves charged with a criminal offense.
If you wind up charged with fraud or conspiracy offenses because of an employer’s financial practices, you will likely want your own defense to help you protect yourself from criminal consequences and the impact that even a plea deal might have on your future employment prospects in the medical industry.