How Can a Nurse or Medical Staff Protect Against Fraud Charges?

How Can a Nurse or Medical Staff Protect Against Fraud Charges?

A large number of the nurses and medical practitioners represented for licensure defense at Surber, Asher, Suber & Moushon, PLLC are accused of medical or healthcare fraud charges. This includes claims that bills were input incorrectly, insurance companies were intentionally sent fake bills, or medical service never rendered were claimed against a government healthcare program, such as Medicare.

An accusation of healthcare fraud is very serious, which is why a Tennessee nursing licensure defense lawyer at Surber, Asher, Surber & Moushon, PLLC would like to see far fewer nurses coming under fire for these actions. There are steps any Tennessee nurse or medical staff member can take to limit accusations of healthcare fraud. Here’s the top five.

#1: Always Follow the Specified Procedure

The hospital, doctor’s office, or dentist practice where you work has specified procedures around billing and billing codes to avoid accusations of health care fraud and other types of malpractice. This reason for process and procedure can become clouded by the events and swiftness of everyday work, but becomes blatantly apparent when there are accusations of fraud.

The very best way to avoid accusations of health care fraud, or other malfeasance, is to follow the specified procedures every, single time. This includes the following procedures that are time consuming or repetitive because they have an underlying purpose, despite their lack of efficiency. If you are unclear or confused why a specific procedure is in place, you can ask a Tennessee licensure defense lawyer or your employer.

#2: Keep Your Licensure Current

You can commit health care fraud by inputting claims or performing other administrative duties with an expired license. It is necessary under every government health care program, including Medicare and Medicaid, that the professional entering billing information and claims for medical treatment be appropriately licensed.

This form of health care fraud is typically a concern for medical practitioners such as doctors and dentists, but even a nurse could be accused of healthcare fraud for letting a license or certification expire. A Tennessee licensure defense lawyer at Surber Asher, Suber & Moushon, PLLC can provide legal advice on how to proceed if your license has already expired. With legal assistance, you can take immediate action to renew your license, with the least amount of consequences of the lapse in licensure.

#3: Request Supervision for New Processes

Hospitals and medical practices are both businesses. The business practices at these entities can become sloppy or mismanaged over time. One common occurrence is doctors and other medical practitioners will delegate tasks to Tennessee nurses and medical staff that are more appropriate for a doctor to handle. In these instances, you should push back on performing the work.

It is beneficial for a nurse in Tennessee to take on new responsibilities and become proficient at various aspects of a medical practice, but not at the expense of your Tennessee nursing license. When you are assigned tasks outside your job description and more appropriate for a doctor, request a doctor be involved in the process or demand supervision.

#4: Report Activity That Is Suspicious

A Tennessee nursing licensure defense lawyer will see several cases in which a nurse wasn’t directly responsible for health care fraud, but was implicit in the offense for failure to report suspicious activities. Sometimes a failure to report a doctor or other nurse’s fraud results in nothing more than an interrogation, but it could also lead to an investigation or audit into your own actions. The least risky action is to report any suspected fraud, particularly in your own department, to a superior or the government through the False Claims Act.

#5: Don’t Make Assumptions About Medical Services

A frequent error in judgment is assuming a doctor administered a procedure or set of services that aren’t clearly indicated on a chart of a medical report. Nurses and medical administrators may incorrectly assume that a doctor performed an x-ray because of notes in the diagnosis, but the diagnosis was made through other means. Simply because an x-ray is expected in the situation, you go ahead and enter it into the billing system. Afterward, you could be accused of healthcare fraud.

Making assumptions about medical treatments is a very risky practice, even when done unintentionally. Instead, rely on the verifiable information provided by a doctor, dentist, or treating physician, and speak to a Tennessee nursing licensure defense lawyer as soon as any accusations of healthcare fraud arise.

You can reach Surber, Asher, Suber & Moushon, PLLC by calling (615) 997-1908.

By |2018-08-15T20:19:08+00:00August 13th, 2018|License Defense, Tennessee Lawyer, Tennessee nursing license defense|Comments Off on How Can a Nurse or Medical Staff Protect Against Fraud Charges?