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All Payers Are Hunting Down Fraud

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at May 15, 2015

There are a few journalists out there in the behavioral health care space that I feel really “get it” when it comes down to what we are facing in the world of regulation (or lack thereof).

Julie Miller with Behavioral Healthcare is one of them.

Her recent blog post: “All payers are hunting down fraud” hits the point rather well that it is only a matter of time, now that Parity is really coming into effect, that insurance carriers are going to come on strong in the enforcement of criminal fraud laws, outside of Medicare and Medicaid.

In her blog, Ms. Miller writes:

  • “Medicare has often been compared to a poorly maintained vending machine: Kick it, and the money just falls right out. Less-than-honest providers and a surprising number of organized crime cells have taken advantage of the weakness, walking away with billions”
  • “In recent years, however, federal officials have allocated more resources to tighten up Medicare’s administrative system against fraud, and all providers need to take note. Fraud can amount to anything from unintentional errors to deliberate upcoding to blatant criminal offenses.”
  • “Fraud allegations can happen to any provider. It’s in your best interest to not only be aware of what’s billable and what’s not, but to back up your operations with proof that you’re doing the right thing.”

I couldn’t have said it better myself.

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