Ask a biller: Insurance fraud and how to avoid it

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Learn what private practice owners should know about insurance fraud with expert Barbara Griswold in this 60-minute Q&A webinar. Answers to 20 important questions from private practice owners.

Questions:
How is health insurance fraud defined for private practice owners?
I don't think I've ever intentionally committed fraud. Can fraud be accidental?
What are the penalties of fraud?
What are common pitfalls clinicians make that result in insurance fraud?
In couples therapy, is it fraud to bill the health plans of both members for a couples session?
If a client is late for a session or chooses to leave early, can we bill for the entire scheduled time, or just the time they were present?
What about after reimbursement/payment from insurance, can you waive any client copay and/or coinsurance that is still remaining?
How can I help clients that struggle to pay and not commit fraud in some way?
Can you give examples of fraud related to diagnosis?
What if I don’t find any diagnosis (other than a personal growth or relationship issue) after the first session?
Is it fraud to continue putting a diagnosis like Major Depression on a claim form after a client has improved?
I just got a records request from an insurance plan. I want to "clean up" my notes. Is this fraud?
My supervisor told me to put her name on the claim form as the Rendering Provider for my sessions. My name isn’t anywhere on the claim. Is this fraud?
Is it fraud to submit a claim from a fully-licensed therapist who has not completed credentialing with an insurance company?
If you realize you made a mistake on an insurance claim and don't correct it in a certain time frame, is that insurance fraud?
What should I do if I accidentally committed insurance fraud?
What steps can you take to you prevent fraud from happening in your practice?
With Medicare, what happens if I get a records review request & my process/progress notes are combined?
Is it acceptable to bill 99080 when doing letters for employers or the courts, or talk to lawyers?


5 Common Types of Health Insurance Fraud: Billing

1. Billing for a service not rendered
2. Changing date of session
3. Changing CPT code
4. Coding telehealth as in-person (or vice versa)
5. Network provider “balance-billing”

Barbara Griswold, LMFT is a private practice consultant and the author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance -- And Whether You Should. She will soon celebrate 30 years in private practice in San Jose. She has taught over 100 workshops on insurance and documentation, been interviewed on NPR’s “Morning Edition,” and her articles have appeared in Psychotherapy Networker and The Therapist. She provides consultations to therapists nationwide, and invites you to contact her at her website, www.theinsurancemaze.com.