Don't expect Medicare fraud investigations to die down soon

The current antifraud climate may be making physicians overly cautious in how they treat patients.

Last fall's election has brought major changes to Washington, which may lead some healthcare providers to assume that recent antifraud regulatory efforts will ease up a bit. However, as Bloomberg reports, combating healthcare fraud continues to enjoy broad bipartisan support, meaning that healthcare providers should continue to expect a continuation of the crackdown on Medicare fraud seen in recent years. While combating healthcare fraud is a laudable goal, many healthcare providers worry that antifraud efforts are making it overly burdensome for physicians to properly do their jobs.

Underbilling and overdocumenting

A number of laws were passed over the past decade that had a dramatic effect on the amount of paperwork that doctors are expected to carry out. Many of those changes were designed to clamp down on Medicare fraud. While Medicare fraud is certainly a problem that needs to be dealt with effectively, the overall antifraud climate has led to doctors being, at times, overly cautious in the way they practice medicine.

As MDedge reports, the new regulations, combined with a fear of being investigated, have led many physicians to underbill their patients out of an abundance of caution. That climate has also led to physicians being especially zealous about documenting their interactions with patients. While overdocumentation is not, in itself, a bad thing, it means physicians are spending an increasing amount of time completing paperwork rather than addressing the medical needs of their patients. The regulatory environment has also forced many private practices to close down and seek greater liability protections through a hospital or larger health provider.

Defending against a fraud investigation

The good news is that despite the new regulations, staying compliant with the law is still relatively easy. Healthcare providers should have a compliance program in place and should also hire a dedicated compliance officer to ensure that the firm is on top of its regulatory obligations. A compliance officer can also help physicians, nurses, and anybody else working at the firm be aware of any new antifraud regulations.

Conducting internal audits is something that should also be done on a regular basis, either once or twice a year. Audits can reveal any systemic errors that may be occurring and help healthcare providers identify potential shortcomings. Those audits should be shared directly with the firm's attorney, that way they will be protected by attorney-client privilege.

Health law help

Staying on the right side of the law isn't impossible for physicians and others who work in the healthcare industry. However, with so many regulations in place and efforts at stamping out fraud increasing, mistakes can happen. Healthcare professionals should consult with a health law attorney for help with any compliance issue. An experienced attorney can help clients who are dealing with fraud accusations or with avoiding such accusations in the first place.