Doctors face scrutiny over billing

The Affordable Care Act has given the government more control than ever before over managing health care fraud and abuse that leads to waste in the system. These types of white collar crime on the part of physicians cost the American taxpayers millions every year, despite the fact that only a fraction of all doctors are guilty of these actions.

The False Claims Act can result in heavy fines if physicians are found to have submitted false reports to the government. This primarily affects physicians treating Medicare and Medicaid patients. The 2010 reform expanded the power of the law and enabled federal officials to more easily conduct investigations against alleged violators. A violation occurs when a physician or other health care professional knowingly presents a false claim for services.

Violations of the Act can include making improper referrals or participating in kickback plans to defraud Medicare or Medicaid. Reputations can also be harmed by these violations and doctors may lose patients. Doctors are advised to institute written policies so that they can monitor the behavior of everyone involved in their practice. Physicians should also understand the rules and regulations under which they are required to operate so that they do not accidentally violate these rules.

Some doctors are targeted for investigation simply because of sweeps decided on by the government to monitor particular types of care, such as plastic surgery or heart disease treatment. However, these random sweeps can endanger honest physicians who happen to have made a mistake in coding or some other minor matter. An Orange County criminal defense attorney may be able to help a doctor who has the best of intentions but has run afoul of increasing government regulations and intervention.

Source:, “Empowered by ACA, old fraud law puts new scrutiny on doctors,” Alicia Gallegos, Feb. 25, 2013

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