Dr. Stu Hoffman of ChiroSecure discussed in his video hangout with Dr. Ray Foxworth, the president of ChiroHealthUSA, another topic that is so important to chiropractors for their practice. They tackled in their 40-minute discussion the five most dangerous things that chiropractors face – all are associated with fines, penalties, and audit. They also provided some very useful insights that can help in a chiropractor’s plan of action to minimize the associated risks.
Chiropractors should be mindful of the following risks in their practice:
- Dual fee schedules
Charging more to insurance companies than they do to cash patients. Why should this be avoided? Because it is considered illegal in many states for the following reasons: misrepresents charges to carriers; False Claims Act violation; may violate Provider Agreements. Furthermore, dual fee schedules can trigger investigations.
- Time of Service Discounts
Here are the reasons why this can put chiropractors at risk:
- Not defined in many states
- More often not defensible
- Often a cover for a“dual fee schedule”
- Not disclosed to carriers as required
- May not be permissible on federally insured’s.
- Inducement Violations
Chiropractors should also not give something away to a patient to make them come into their office or to induce patients to come into their office. If one does that, it’s a $10,000 fine for the OIG, 2009 special alert bulletin. In connection with this, chiropractors should note what the OIG has stated:
- “incentives that are only nominal in value are not prohibited by the [Inducement Law]”
- No more than $15 per item, or $75 in the aggregate on an annual basis.
- One free exam, x-ray or therapy is a risk.
- Anti-kickback Violations
A person who offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of Medicare or Medicaid payable items or services may be liable for civil money penalties (CMPs) of up to $10,000 for each
Many states have adopted federal rules/regs.
- False Claims Act Violations
What does the law state? The False Claims Acts “prohibit any individual or business from submitting, or causing someone else to submit, to the government a false or fraudulent claim for payment. These false claims acts apply to all types of goods, services and government contracting…”
In other words, the law prohibits: knowingly presenting, or causing to be presented a false claim
for payment or approval.
Here are some examples:
- Waiving deductibles or co-payments and not reporting to carriers
- Up-coding for higher reimbursements
- Down-coding based on payer type
- AAPC Article: http://news.aapc.com/index.php/2014/04/undercoding-is-no-better-than-overcoding/
When to offer discount?
The only time chiropractors offer a discount is when it is required by mandate, or by contractual agreement, or a documented hardship.