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6 Ways to Avoid Unintentional Medicare Fraud

Greg Freeman, January 30, 2014

6. Working too quickly. Some CPT codes are estimated to last 20 minutes to a half-hour, for example. If you are billing for these procedures five times an hour or 50 times a day, your justification that you are just faster than average may not cut it.

In your mind that is not fraud because you know you provided the service," Dagli says. "But an outside observer will say that is just not possible. You may be far more efficient than some of your peers, but you cannot bill for more than what Medicare says can reasonably be done in the time specified."

Remember that with many of these examples, the actual error may be committed by the practice staff. Even so, the physician can be investigated and charged, and have a difficult time defending the charge, Dagli says.

"The physicians ultimately are going to be accountable, so it is to their benefit to get involved directly in preventing these pitfalls," he says. "You should be able to concentrate on patients and leave the billing to someone else, but the reality is that you have to know what's happening."

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