Is this insurance fraud?

Question

I work for a mental health therapist's office. There are ten different therapists, each independently contracted. I have been asked to schedule a patient with one therapist but list someone else as the actual therapist because the one they are seeing does not take their insurance. I have seen insurance be billed with a fake date on it because they took too long to submit a claim and the time to file had expired so they would not have gotten paid on it. I have been asked to call patients that are scheduled with one therapist to see if they want to see someone else because the "someone else" doesn't think they have enough patients and not making enough money, but tell the patient it's just to see if they can get in earlier.

Just wondering, there are a few other things, not illegal, just really unethical....I am just the front office admin so not really sure about the laws of insurance, just wondering...

Answer 1

The part about seeing a doctor then listing another doctors name is fruad, that is a big deal.  The post dating thing for insurance is fraud but not as big of a deal, from my understand is that it is very common.

The asking a patient to see someone else because of money isn't a big deal.

Answer 2

Filing a claim with anything other than the actual, true provider, procedure and diagnosis codes, date of service, etc... is fraud. However, I can tell you that back dating, provider switches and code modifications are done all the time by health provider's billers.

Answer 3

Usually if you have to ask if something is wrong, then your gut is already telling you that it is, and in this case your gut is bang on. Fraud 1: Intentionally listing the wrong therapist on the form in order to make the insurer think the one that they can bill did the work.

Fraud 2: Intentionally placing an incorrect date on the form in order that they bill falls within the billing period.

The third situation is more unethical, as the welfare of the patient is not being put first.

If I were you I would consider looking for a new job. This sort of c**p is eventually going to hit the fan, and when it does don't think for a second it won't get on you.

Answer 4

Yep, falsifying medical documents and claims form, IS insurance fraud.  And, it's illegal.

Answer 5

Yep it is insurance fraud and guess who will be the one the Highway Patrol comes in to arrest along with the OIG (office of inspector general)...YOU. The people asking you to do that will be introuble too but you are the one that did the claim, you are responsible.

Answer 6

yes it is.