Consistent practices when it comes to billing do more than help providers keep track of their resources and match federal laws: They could also help prevent wrongful activities through comprehensive checks.
A doctor in New Jersey, Albert Ades, has been arrested for several cases of potential healthcare fraud, in which he may have made false health claims for patients over the course of nine years for medical tasks, including prescriptions and patient consultations, that never happened.
By maintaining best practices for billing with a medical billing consultant, healthcare entities could feel more confident about how bills are processed. Dr. Ades' alleged crimes supposedly went beyond just falsifying appointment dates, according to the Associated Press.
He also stands accused of enlisting co-workers to help him forge medical documents to support his false claims. Overall, the source says he is facing "35 counts of making false statements relating to health care matters" and a potential 10 year prison sentence for just one of the charges alone.
The text of the official indictment, quoted by a press release on the website for the United States Attorney's Office District of New Jersey, describes how the doctor supposedly tried to avoid being detected.
"When one insurance plan initiated an audit after a patient reported Ades for billing prescription refills as office visits, Ades shredded original medical records and created bogus medical records to obstruct the audit," he said. "Between 2008 and 2013, at least four individuals working at Ades's medical offices told Ades that his billing of prescriptions or refills out as office visits was illegal."
Bad billing schemes could impact patients, practices and insurers. Practices could use healthcare consulting firms for help in important tasks where regularity and attention to detail are necessary.