How To Prevent Fraud and Abuse in Healthcare

how to prevent fraud and abuse in healthcare

Concerned about fraud, abuse, or errors within your medical practice? These issues may come from errors or intentional system misuse. They almost always point to someone with internal access. 

Although some issues, like claim denials in medical billing, happen accidentally, a person creating fraudulent or abusive instances does so purposefully. The team at PracticeForces shows you how to prevent fraud and abuse in healthcare practices below. 


#1. Avoid Unnecessary Treatments

Before performing diagnostic tests or using treatments on your patients, ensure that you have sufficient evidence to warrant these services. Many people undergo too many tests, treatments, and services, which proves detrimental to their finances, mental well-being, and trust in medical institutions. While you want to ensure each patient receives the attention and care they need, you shouldn’t over-treat them. Doing so can put your practice at risk of fraudulent charges while eroding its reputation. 


#2. Practice Data Security

Data breaches are a growing concern for all businesses — especially medical service providers. Proactively secure your practice’s data by practicing the following:

  • Keeping each medical record and data source encrypted and HIPAA-compliant
  • Regularly updating your digital infrastructure
  • Preventing outside devices from accessing your internal network
  • Seeking legal assistance in the event of a data break

These habits are integral in learning how to prevent fraud and abuse in healthcare settings.


#3. Eliminate Kickbacks

On the other hand, you should avoid overusing patient referrals, especially when you receive significant kickbacks. Use caution when partnering with a practice that offers any type of reward-based system for referring patients. While not all kickbacks point to suspected fraud, they can increase incentives to misdiagnose and over-treat patients. 


#4. Keep Related Services Bundled

A practice may engage in fraudulent activity by unraveling service bundles, especially involving patients who require government-funded Medicaid services. Medicaid offers a guaranteed profit stream for practices that accept its coverage. As a result, the staff in charge of medical billing may charge for each service rather than keeping them bundled as intended.

Remain vigilant about how your practice bills Medicaid-funded services. Even small errors could result in an abuse or fraud case.  


#5. Perform Audits and Updates With Medical Billing Solutions

The many advantages and challenges of medical billing include continuous solution upgrades. Each issue mentioned above has a computerized solution, such as third-party auditing. If you run a small practice, you may not have the resources for in-house auditing or software updates.

Third-party medical billing solutions assist practices of all sizes in protecting their patients, reputation, and staff from errors, fraud, and abuse. Explore medical billing services that include the following:

Reputable medical billing solutions create a secure digital ecosystem for your practice to deliver consistent care quality and obtain reputable, data-backed collections.  


Learn More About How To Prevent Fraud and Abuse in Healthcare From PracticeForces

Understanding how to prevent fraud and abuse in healthcare often starts with medical billing fraud prevention. Fraudsters usually target financial resources above all else. PracticeForces can assist you in protecting your practice and patients with extensive medical billing solutions.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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