What should doctors do if they discover fraud?

You may think that you will never face allegations of healthcare fraud. However, even small medical offices can have problems with fraud. If you think that you or one of your staff members is unintentionally committing fraud, there are certain steps you should take.

Correct the problem

According to the U.S. Department of Health and Human Services, you may face allegations of healthcare fraud if you work with companies who engage in suspicious practices. As soon as you realize that these companies may be taking unethical or illegal actions, you should stop working with them. Sometimes, the problem may stem from your billing procedures. You should typically go through your bills to identify the problem. Did one of your staff members overcharge a patient or send a bill for a procedure that you did not do? You should make sure you return overpayments and tell your staff not to file bills that look suspicious. If the problem is larger than you realized, you may want to report it. The Office of Inspector General, part of the U.S. Department of Health and Human Services, has self-disclosure guidelines that your office can follow. If you choose to take this step, you usually work with investigators to stop potential healthcare fraud at your practice.

Prevent future problems

Once you stop an incident of healthcare fraud, you should make sure the situation does not happen again. You should usually conduct training so your staff members recognize the signs of fraud. This helps ensure that every member of your staff can identify and prevent potential problems. Additionally, you may want to conduct an internal audit periodically. If you do not already have a compliance officer, you may want to appoint someone to this position.