Double billing represents a significant issue in the healthcare industry. Inadvertent double billing unnecessarily increases healthcare costs, while intentional double billing can constitute a crime. Healthcare providers should understand what activities may qualify as double billing and what preventive steps they can take to prevent or mitigate double billing within their organizations. An experienced healthcare attorney at Herman Law Group can help you assess your risk and develop tailored legal solutions to address future double billing or existing violations. Contact us today to learn more.
What Is Double Billing?
“Double billing” refers to the practice of billing more than once for the same patient encounter, item, or medical procedure. Double billing can occur in invoices sent to patients, although it more frequently occurs when healthcare providers submit claims to insurance companies or Medicare/Medicaid for reimbursement. Common examples of double billing include:
- Submitting a claim for the same procedure or encounter to Medicare and a private insurer, if a patient has both Medicare and private health coverage (such as private health insurance or personal injury protection coverage from auto insurance)
- Billing for the same procedure under different billing codes
- Having multiple departments or facilities bill for the same treatment or service
- Submitting a second claim for the same patient service using altered or falsified records to make it seem like services occurred on different days
Double billing differs from other unlawful healthcare billing practices, such as upcoding (billing for services using a code representing a higher level of service than actually provided) or unbundling (billing separately for multiple components of a service that fall under a single, comprehensive code).
Why Double Billing Occurs?
Double billing can occur inadvertently or as part of an intentional fraudulent scheme. Common unintentional causes of double billing in healthcare include:
- Inadequate communication between departments or between clinicians and administrative/billing staff that leads to duplication of claims
- Use of multiple billing/claim systems
- Inadequate training of billing staff
- Clerical errors in completing insurance claim paperwork
Healthcare provider double billing can also occur due to intentional misconduct, such as:
- Efforts to increase practice revenues
- Fraudulent schemes within large healthcare organizations, such as efforts by individual providers to gain extra income or schemes that involve kickbacks to billing staff
Legal and Regulatory Implications of Double Billing
Double billing by healthcare providers may violate various laws, including the federal False Claims Act (for double billing of Medicare and Medicaid) and the Anti-Kickback Statute. Double billing state Medicaid programs and private health insurers may also violate state anti-fraud laws. Healthcare providers caught double billing may face consequences that include civil penalties/fines, judgment liability owed to insurers, exclusion from private health insurance networks or Medicare/Medicaid, and potentially criminal charges and penalties.
How to Detect Double Billing
Medical professionals and healthcare providers can detect double billing in their practices by adopting audit and claim review programs designed to catch double-billed insurance claims. Ideally, providers can detect potential double billing issues before sending claims to insurers, which may result in legal consequences for providers if an insurer detects or pays a double-billed claim.
Insurers and other parties also watch out for potential double billing by healthcare providers. Private insurers and government healthcare programs, such as Medicare and Medicaid, also audit providers’ claims to detect double billing. Insurers increasingly rely on computer-based data analytics and AI reviews to conduct billing oversight. As AI tools become more prevalent, healthcare providers can also leverage them to bolster their internal claims audit processes.
Insurers and government regulators may also learn of healthcare providers’ double billing through whistleblower actions. Whistleblowers, such as employees in healthcare organizations, may report suspected double billing to government regulators. However, when providers double bill Medicare or Medicaid, whistleblowers can also file qui tam lawsuits on behalf of the government, although government officials can intervene in qui tam actions to take over prosecution of the lawsuit.
Double billing of Medicare and Medicaid can also lead to involvement by the Office of the Inspector General of the U.S. Department of Health and Human Services. This office accepts reports or tips of provider double billing that may lead to fraud or waste in the Medicare/Medicaid system.
Best Practices for Healthcare Providers
Healthcare providers and medical practices can implement various best practices to avoid potential incidents of double billing, such as:
- Developing and implementing an internal audit and claim review program to detect potential double billing issues as early as possible
- Establishing a compliance program that encourages staff to report suspected double billing
- Adequately training billing and coding staff and facilitating staff’s efforts to obtain applicable certifications
- Facilitating clear communication channels between clinicians and administrative staff
- Working with experienced healthcare compliance lawyers to evaluate risk and develop more robust internal policies to prevent or detect double billing
What to Do If You Suspect or Discover Double Billing
When you suspect or discover double billing in your medical practice, steps you should take to protect your interests and prepare for potential legal action include:
- Conduct a thorough internal audit and investigation to confirm whether double billing occurred and determine the cause(s) for the double billing
- Develop and implement corrective actions to address the factors that led to the double billing
- Preserve all relevant evidence, including billing records, computer system metadata, patient records, emails, and insurance company correspondence
- Engage legal counsel as soon as possible to evaluate your legal options
- Consider self-reporting to government regulators, if advised to do so by your legal counsel
How Our Firm Can Help
The dedicated legal team at Herman Law Group can help you keep your billing practices consistent with insurance company rules and state and federal laws. Turn to our firm to protect your practice from double billing violations by:
- Conducting legal risk assessments and assisting you with developing internal audit practices
- Advising you regarding voluntary disclosure protocols if you detect double billing violations
- Helping you conduct compliance training and policy development to prevent future double billing errors
- Representing you against civil lawsuits filed by insurance companies or government investigation/enforcement actions
Contact Our Firm Today for Experienced Guidance
Double billing violations can have significant consequences for healthcare providers and medical practices. Health insurance providers may pursue civil actions against providers to recover overpayments. State and federal regulators may also seek enforcement actions that could result in sanctions such as fines and license suspensions. Proactive compliance and oversight measures can help you avoid double billing mistakes that could jeopardize your practice. Contact Herman Law Group today for a confidential consultation with our experienced attorneys to learn more about safeguarding your organization.