Theyíre watching - How to stay off the radar

Published: 2009-12-25 20:37:42
Author: Chiropractic Economics | December 2009

Youíre with a patient. More are in the waiting room. Thereís a commotion. Men in uniform sweep into your office and a guy in a suit brandishes official looking paperwork in your face. As they execute their search warrant, they take photographs, your computer, and some patient files. Then they leave you in a state of shock.

Think I created the above scenario to get your attention? Sorry to disappoint you. Over the past few years, scenarios like this are becoming more common. And you wonít see your colleagues blog about it either. Once theyíre caught in the spotlight, itís all they can do to catch a breath. 

It could have been local law enforcement, but itís more likely state or federal. For instance: DHHS/OIG, better known as the Department of Health and Human Services, Office of the Inspector General.

I know what youíre thinking. This goes way beyond an audit. These doctors must have done some pretty brazen things to merit a search warrant! Iíd never do anything like that. Criminal? Fraud? Not possible!

Guess again. Itís easier than you think. One of the simplest ways to head down the path ultimately labeled  ďfraudĒ is your CPT codes. What problem could possibly result from your codes? Imagine that a CPT code you use regularly isnít getting reimbursed. Youíre buddy, Bob, letís you know that heís having better luck with a different code. Or perhaps your management consultant provides something better. The alternate doesnít seem too different, so you switch. Later, this becomes part of your defense argument as you protest your innocence during talks over a two year period with the investigators sifting through your data.

Letís look at an example. Suppose that 5 years ago you began using 97012 as part of your office visit to account for extended time with the patient. Today, you wonder why the investigators photograph your office as part of their intrusion. And later you learn theyíre looking for mechanical traction equipment Ė which you donít own. You tell your attorney that every chiropractor you know locally is using that code.

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