Ethical Billing Practices in Healthcare

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Ethical Billing Practices in Healthcare June 24, 2012 Submitted to Amanda Walters Thesis: When we visit the doctor, we often do not think of what happens behind the scenes when we leave. While most doctors adhere to a high level of ethics when it comes to patient care, there are still those that will bend those ethics when it comes to billing. Medicare fraud is on the rise. Whether it be to make a diagnosis match the procedure being performed or to charge a higher rate for a procedure that was performed at a lower rate, it can pose an ethical dilemma for all employees in the practice. I will discuss what Medicare Fraud is, some cases of Medicare fraud, the consequences of committing Medicare fraud, and the ways to prevent and report it. Issue: Doctors are usually thought of as having a higher set of ethics in the business world. When a doctor swears to the Hippocratic Oath of “Strive to help, but above all, do no harm,” most people think about the treatment of patients. However, this can also be stretched to anything relating to the care of a patient, including how insurance claims are handled. There is a certain expectation that a doctor is an ethical individual that will always do the right thing and take proper care his patients. (Ruddick, 1998) Medicare fraud happens when a doctor bills Medicare for services that a patient did not receive, bills for a higher level of care than a patient received, or bills for supplies and medications that a patient did not receive. All of these things usually happen without the knowledge of the patient. Sometimes the patient will catch these errors on their Medicare summary. Often, if the patient is elderly, they may not understand their summary, and they may just assume they received the supplies or procedures being billed. In the case against William Holley, DPM, he is accused of knowingly and willingly scheming

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