Avoiding Fraud and Noncompliance Perpetrated by Staff Members

Most professionals rely on a staff of dedicated administrators and assistants to maintain their practices and remain profitable. However, there remains an understanding in most professions — the medical profession included — that the professional ultimately bears responsibility for the actions of his or her staff members.

Carelessness or simple mistakes by staff members can lead in many ways to compliance issues for medical professionals. Deliberate fraud, however, poses a different problem. While instances of health care fraud by doctors often receive wide publicity, fraud can just as often be perpetrated by office staff without the knowledge of the supervising professional. Nevertheless, a medical professional who allows such conduct to occur within his or her practice almost certainly experiences harsh consequences even if not directly involved. For this reason, medical professionals have a duty to themselves to monitor their staffs to ensure these practices are not occurring:

  • Redundancies — While likely unavoidable for small practices, having one person responsible for the entire claims process can make it easier for mistakes or deliberate fraud to go unnoticed. Setting up a system that allows each person’s work to be reviewed at some point can help detect any problems.
  • Set procedures — Having set procedures for handling insurance and Medicare/Medicaid claims makes mistakes and oversights less likely. Scheduling audits to catch small problems before they turn into big problems makes sense.
  • Require training — Medicare/Medicaid regulations are constantly changing. However, even without these changes periodic refreshers on the applicable rules can help prevent complacency.

Virtually every medical practice has constant interactions with both private and government insurance. Consulting with a New Jersey health care law firm that understands compliance issues can help medical practitioners take proactive steps toward avoiding fraud and abuse.

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Posted in: Compliance, Healthcare Criminal Defense