The OIG is diligently investigating claims of medical identity theft identified by fraudulent medical bills submitted to insurance companies identified once the explanation of benefits is received by the subscriber; and audits triggered by fraudulent claims submitted for reimbursement the system flags due to pre-existing condition or medical necessity, among other methods. Your compliance program should have guidelines and protocols in place to address audits and also prevent medical identity theft.
Medical identity theft is a growing concern and occurs when someone steals personal information along with insurance identification numbers to obtain medical services and prescriptions, and to submit fraudulent claims to insurance carriers. As part of your compliance program, systems should be in place to prevent exposure of patient information and liability, such as:
- Locking computers when finished working to prevent access to personal information, which is extremely important for offices with computers in exam rooms;
- Filing charts instead of leaving them around the office; and
- Conducting background checks on your employees.
The entire practice team is pivotal in the prevention process. Here are some tips to reduce liability and sustain compliance measures.
Medical Identity Theft: Are You at Risk?
- Are the computers in your office unlocked when employees walk away?
- Are patient charts left unattended in areas frequented by patients?
If you answered yes to either of the questions, your practice is liable and at risk for an investigation. Protecting your practice requires a commitment to compliance from all staff members.
- Act promptly when served with audit papers, and respond immediately with a standardized letter (for samples, visit www.rheumatology.org/practice).
- Understand the current medical audit landscape and how it affects you as a physician and your practice as a whole.
- Understand the importance of documentation as it relates to patient safety, provider protection, and quality care.
- Remember that accurate coding and billing are critical and must support medical necessity for every visit to avoid stiff penalties.
- Develop a general understanding of the audit appeals process and your rights within the process for each type of audit or auditor.
- Know key risk areas on which the government will focus and learn practical approaches for reducing your risk and exposure.
- The OIG is committed to reducing fraud and abuse in Medicare, Medicaid, and Health and Human Services. Some of the services offered by the government agency are compliance guidance and physician education and training on avoiding investigations derived from identity theft and audits. The OIG resources expand to assist during the investigation process and provide guidance on the crucial guidelines required to position physician practices to adapt and sustain healthcare reform initiatives. These resources can be found at http://oig.hhs.gov.
The ACR Is Here for You
The ACR has online forms available at www.rheumatology.org/practice to assist you with proper documentation.
