Medical Coding and Billing Mistakes vs. Fraud

Medical Coding and Billing Mistakes vs. Fraud

Medical coding and billing mistakes can hurt your practice in many ways. They can interrupt your cash flow, especially if a group of claims has been submitted to a payer and each contains the same or similar mistakes. They can also gobble up time, as you correct mistakes and, perhaps even submit supporting evidence in the appeal process.

Plus, coding and billing mistakes can trigger audits and investigations. In a worst-case scenario, they can lead to charges of fraud, forever damaging your reputation and ruining your practice. Of course, there’s a big difference between making a mistake and engaging in fraud. But the fact is habitual mistakes, ongoing rejection of claims, and questionable practices can lead to suspicions. And even though you may never be brought to trial or convicted, the stigma associated with even a hint of fraud can be extremely damaging.


Health insurance fraud occurs when a healthcare practice purposefully submits inaccurate claims with the intention of defrauding payers. Often doctors who submit a high volume of claims, create bills with excessive charges, or perform unneeded services find themselves facing such charges.

Investigations can take years, consume precious resources, and result in the loss of your medical practice and revocation of your license. Those who engage in fraud and are caught in essence lose everything and can certainly end up serving time in prison. Thus, fraud, which is usually prosecuted by the state but may be prosecuted by the federal government, can derail and destroy everything you’ve accomplished.

Thus, it’s important that doctors and other medical professionals protect themselves by never engaging in fraudulent or even questionable activities that may raise suspicions. That means always paying attention to details when submitting claims, keeping solid records of all activities, and making sure you adhere to all laws and regulations.

No Difference

Ambulatory Surgery Center BillingIn one way, there is no difference between mistakes and fraud, That’s when, whether you have made honest mistakes or have actually committed fraud, you are charged with such. This is why it’s very important that you take medical coding and billing errors seriously and act quickly to both correct specific errors being made while evaluating and correcting the factors that are responsible for those mistakes.

Outsourcing Your Invoicing

If you’re still handling your medical billing and coding in-house, you may want to seriously consider outsourcing these duties. Doing so will give you access to a range of coding and billing professionals and a whole stream of services. Outsourcing saves money, is often more efficient, and it gives you access to an independent party who can assess your claims, ensuring their veracity and viability.

In a way, utilizing an independent medical billing and coding company allows you to make some mistakes, as one of their primary jobs is to catch errors before a claim is ever submitted to a payer. Finally, by outsourcing these services, you and your co-workers will be able to better focus on what you do best, provide healthcare services comfortably.

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