Medical Billing Memo
Today, a medical assistant has asked to speak privately with me, the office manager, about a matter that she is greatly concerned about. She makes an accusation of fraudulent billing that is against one of the medical doctors on staff. The medical assistant alleges that she has noticed recently in the past few months that this particular doctor has repeatedly been upcoding higher evaluation appointment code descriptions for all of his Medicare patients’ appointments. She believes that these visits should have been listed with lower medical description codes for billing purposes.
I would thank the medical assistant for coming to me with this information. I would assure her that she has done the correct thing by bringing this to my attention. I would ask her to give me any specific patient billing records that she is concerned with as being inaccurate. I would ask her to please not repeat this information to any of the other employee staff members at this time. I would assure her
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I would immediately cease filing these bills. I would then need to show these records that have inaccuracies that I have noticed to this particular doctor and ask for any explanation of his knowledge of these inaccuracies. I would then listen to him to see if he denied that there was any wrong coding on his part or if he was unaware that he had coded them inaccurately or if he disagreed that there was any incorrectness at all in the coding of them. If I believe that there are fraudulent activities or mistaken coding that has taken place, I would then contact the proper Medicaid authorities and an attorney. Yes, I would seek legal action because I would need to protect myself, the medical assistant, and both of our careers from any involvement with fraudulent
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