Home > Reconsiderations > Chiropractor Gets Audited for Fraudulent Billings

Chiropractor Gets Audited for Fraudulent Billings

Chiropractors are susceptable to fraudulent billing practices by not having trained personnel billing state agencies. Unbeknownst to the doctor, the staff knows that Workers’ Compensation Departmetns will do reconciliations and send back an exceptions report telling the person what correct codes to use and correct the charges, too.

Unfortunately, the Departments flag these exception reports and monitors them. Then, they can decide to audit the business. In this case they charged the doctor with Felony B criminal charges for 35 patients he had treated in a 3 year period. In Washington, there is a specific law that says the doctor is ultimately responsible for any of his employees billing practices. This may be true in your state, too.

After completing my external audit on what the state considered criminal, he was guilty of sloppy records and chart keeping. His rate of turnover of staff was terrible. He used mostly young women at the desk and billing station with no check s and balances of any kind. The cash, checks, and warrants were posted into a separate Quick Books program with no postings on the patient charts information. The accounts receivable was about 60 percent of billings.  He could not figure out why he was not making any money.

After placing internal controls, training the office staff on how to properly fill out the charts, post daily visit slips to the charts, and devise guides for using the correct LNI and Medicare codes to prevent over billings and reduce the exceptions reports, the doctor was fine. A little business 101 lesson helped, too. And, the felony B issue is still being negotiated via a really good attorney. The entire audit was assesment was redueced to $12,000, not the initial $60,000+ estimated.

Give us call because we have the staff to defend you. Better yet, buy our software so you do not have to go through  anything like this at www.WKRComp.com.

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