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Fraudulent Billing and Legal Implications Essay
Fraudulent, Billing, Legal, Implications, Essay
In the article by Brenner, Teo, and Bal (2017), it is explained that the United States has the highest healthcare expenditures of other nations, such as the United Kingdom, Australia, Germany, and France, and that the federal government is concerned that fraudulent billing may be responsible. Fraudulent billing is when a healthcare provider attempts to obtain monetary gain from any healthcare benefit program through false billing or other misrepresentations (Brenner, Teo, & Bal, 2017).
A statute titled 18 U.S.C. § 1347 states that in order for the government to obtain conviction, the guilty party is not required to have knowledge of the relevant law or specific intent to commit violation of that law (Brenner, Teo, & Bal, 2017). Many healthcare providers will receive penalties and fines for fraudulent billing, but criminal penalties, such as prison, are also a possibility (Brenner, Teo, & Bal, 2017).
Collaborative Versus Independent Practice
A nurse practitioner is always responsible for the care that she gives to her patient, regardless of practicing independently or collaboratively. The well-written medical record is imperative because it may be the only defense for the nurse practitioner in a claim of fraud or malpractice.
Being found guilty of billing fraud may result in being unable to bill insurance and maintain licensure (Dolan & Farmer, 2016). The medical record can demonstrate that fraud did not occur, the standard of care was met, safety principles were followed, and the best practice was rendered (Dolan & Farmer, 2016).
The primary difference in fraudulent billing between collaborative and independent practice is that when services are billed under the collaborating physicians NPI number, that physician may incur repercussions, as well (Rapsilber, 2019).
These repercussions include jail time, fines, and relinquishing of ability to bill insurances (Rapsilber, 2019). Executives in positions of authorities can, also, be held accountable due to failure in its oversight duty to monitor (Brenner, Teo, & Bal, 2017).
Brenner, L. H., Teo, W. Z. W., & Bal, B. S. (2017). Medicolegal sidebar: expanding hospital liability-the concept of willful blindness. Clinical Orthopaedics & Related Research, 475(5), 1315. https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edb&AN=122406803&site=eds-live&scope=site.
Dolan, C. M., & Farmer, L. J. (2016). “Let the record speak. . .”: The power of the medical record. The Journal for Nurse Practitioners, 12(2), 88–94. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2015.09.018
Rapsilber, L. (2019). Coding & billing practices. Incident to billing in a value-based reimbursement world. Nurse Practitioner, 44(2), 15–17. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NPR.0000552680.76769.e5.