Insurance Fraud Networks Affecting Florida Healthcare, Physicians Turn To Medicalbillersandcoders.Com For Ethical And Knowledgeable Billers

Sunday, June 5, 2011

WILMINGTON, Delaware, June 6, 2011 -

The level at which healthcare insurance fraud operates in Florida
( has
shocked the National Health Care Anti-Fraud Association and The Department of
Financial Services, a division of Insurance Fraud, that investigates frauds
for all types of insurance. The intensity with which the frauds are planned
has alarmed the investigators and given them enough reason to investigate
just about any clinic's claims.

- Physicians in Florida have paid Medicare beneficiaries to
sign papers for the treatment that was not administered and use their
Medicare numbers to bill Medicare

- Physicians support up-coding and un-bundling mostly for expensive
drug infusion treatments for blood disorders

- Falsify medical records to show severe symptoms

- Hire specialized billing companies to bill Medicare

- Bill for deceased doctor

- Bill for doctor not available at PoS to Medicare

Consequences for physicians with such dubious intentions of course has
been a sentence of ten (10) years and financial penalty depending on the
level of fraud.

National Health Care Anti-Fraud Association estimates that nearly $51
that is approximately 3% of the healthcare industry's expenditure in
the United States is due to fraudulent activities. However, it is difficult
to gauge the extent of fraud but it is estimated that annually $115 billion
is drained out of the system.

Shocking it is, but medical fraud is highly prevalent in Florida;
physicians gain financially and most patients feel they are not affected as
insurance takes care of the expenses even if it is fraudulent. Unfortunately
they do not realize that because of such practices insurance companies hike
premiums that increase the cost of healthcare.

There is also a certain section of physicians who believe in billing only
for the services provided and at appropriate cost ethically, but these
physicians are unaware of the billing and coding practices. Such physician
practices are dependent on billers and coders who may or may not fully
understand the implications of incorrect or fraudulent billing.

Incorrect or fraudulent practices over a period of time can land a
physician's practice under the scanner of Recovery Audit Contractor (RACs).
Suspicious claims are submitted to the "special investigative units", or
SIUs, for further investigation. These units generally comprise experienced
claims adjusters with special training in investigating fraudulent claims.
These investigators are experts in cracking patterns of fraudulent claims,
and look for evidence of falsification of any kind.

RAC reviews the last three years of provider claims with the help of
proprietary software to identify potential payment errors in duplicate
payments, mistakes of fiscal intermediaries', medical necessity, and coding.

Unintentional errors in billing and coding should not make you liable to
these audits and hamper the credibility of your practice. Experts at have been investigating these audits closely in
Florida and have found that the main reason for Insurance Fraud allegations
on a clinic is when the administration is handled by novices or non-certified
billers. The negligence and lack of a forum to discuss issues such as
unbundling, using more expensive codes, uncertainty in the use of modifiers,
and adding referrals appropriately can easily be sorted out with a network of
knowledgeable billers. (,
the largest consortium of Medical Billers and Coders is looking to combat
ignorance and fix insurance fraud indicators, though the observations started
from Florida but its awareness and solutions are being implemented across 50
states where the consortium extends its membership. Physicians currently
being assisted by are also appreciating the
efforts of the association to educate and train billers against unintentional

About is the largest 'Consortium of Medical Billers
and Coders,' across the US. The portal brings together hundreds of billers,
with experience in different specialties, on the same platform to service
physicians in their local areas. This network of coders and billers is
growing rapidly and is currently servicing over 50 specialty physicians,
across the US, with the most prominent being Cardiology (,
Mental Health (
, Dental (,
Oncology (,
and General Practice.

    Prerna Gupta, Media Relations
    108 West, 13th street,
    Wilmington, DE 19801

    Tel: +1-888-357-3226


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