It's bad enough when an individual practitioner attempts medical billing fraud: when it happens on a grand scale, all taxpayers feel the burden. But Medicare Advantage seems to have been involved in a large, fraudulent billing scandal that may be responsible for billions of dollars of unnecessarily high payments.
This story comes from the Center for Public Integrity, which examined the ways that multiple states showed examples of unjustified instances of billing. According to findings of a study the Center conducted, "nearly $70 billion" was spent over a six year period on Medicare Advantage. The article on this practice asserted that much of the problem stems from an over reliance on risk scores which might not be accurate.
The different regions of the country offered up examples of where this has taken place, which include regions as diverse as Florida and Las Vegas. These cases may show how a medical billing consultant is needed no matter where a practice may be located to stick to proper regulations and not overcharge.
In addition, USA Today recently reported on a separate investigation undertaken by the Department of Health and Human Services. This organization found that, in 2010 alone, the wrong codes were used for more than 40 percent of "diagnostic and assessment claims." The source also notes the added complication of having to distinguish from the actual errors that are likely to arise and those that were clearly intending to abuse the system.
These numbers are staggering, and could only become worse as they mount up over the years. Seek out healthcare coding and consulting services soon in order to make sure that problems are not being forgotten or glossed over.