Keep an eye on your billing companies.
If you use a billing company you will want to read this story coming out of Miami Florida. The Miami Herald originally ran this article, Their company did medical billing. Now, four of them are headed for federal prison by David J. Neal. This is a pretty sobering situation for anyone who uses a billing service. You need to make sure that they are not committing fraud on your behalf. We have a billing company that was creating fake super bills on behalf of their clients. Patient Options helps mitigate your fraud potential but you are responsible to make sure that all the parties involved are not up to anything dastardly. lets look at the excerpts here…
Little Havana’s Billing USA offered a comprehensive menu of services for its medical business clients, from basic billing to complete financial falsehoods that made multimillion-dollar healthcare fraud almost cut-and-paste easy.
Friday’s conviction of Billing USA office manager Francel Rodriguez on one count of conspiracy to commit healthcare fraud is only part of the story. Several other associates also will be offered a comprehensive menu of federal prison food over the next few years.
Billing USA’s owner Mauricio Palma, 45, is in the downtown Miami Federal Detention Center, a few months into his eight-year sentence after pleading guilty to conspiracy to commit healthcare fraud. Palma’s also hit with $2,110,173 in restitution and lost $1.8 million in forfeiture.
Also in the downtown Miami prison: 42-year-old Rafael Izquierdo-Rios of West Miami-Dade, who earned a sentence of six years and five months. Izquierdo-Rios helped run Billing USA and also used the scam at his own billing company, American Fast Services, to skin Blue Cross Blue Shield, Cigna and UnitedHealthcare for $2,278,702.
As explained by the Department of Justice in an emaill, “In some cases, clinics provided Billing USA with completed super-bills, which specified what they wanted to have billed on their behalf. Billing USA would transcribe the super-bill into the official documents accepted by the insurance companies. Billing USA charged a six percent fee of whatever the insurance companies paid for the claims for this option.”
But, Billing USA showed a knack for service, going that extra white collar criminal mile for its customers.
For other customers, Justice explained, Billing USA “offered to fabricate the super-bill entirely for the clinics. In these scenarios, clinics would only have to submit patient information to Billing USA, and employees would fabricate a super-bill, bill the insurance companies for whatever the patient’s insurance plan would allow, and then inform the clinic of what they had billed so the clinic in turn could fabricate patient files to reflect the same.”
Patient options will always do our best to mitigate your fraud potential.
Thanks to Miami herald and David J Neal for their article.