A false claim is when a person knowingly presents a fraudulent claim for payment. Deliberately billing for services not performed. Misrepresenting services rendered (Upcoding or inappropriate) and misrepresenting the nature of a patient’s condition. Billing single items when they are supposed to be part of a group. False claims include, DRG, PPS, Medicare kickbacks, outpatient PPS, Stark law violations (limitation on certain physician referrals), DME fraud and DRG fraud.
Mistakes and errors are not considered fraudulent behavior; it is considered abuse since it is done accidently like entering a wrong code.
The compliance program is for educating physicians who have an individual or small group practices in how to avoid generating false claims.
Mistakes and errors are not considered fraudulent behavior; it is considered abuse since it is done accidently like entering a wrong code.
The compliance program is for educating physicians who have an individual or small group practices in how to avoid generating false claims.