Medical Billing

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unethical dental billing practices

7 Unethical Dental Billing Practices To Avoid At All Costs

As a dental healthcare provider, you must exercise safety measures at every step of billing. You already know certain regulatory authorities keep a check on what you do and services provide to patients, so it is essential to understand some unethical dental billing practices to avoid them.

Due to increasing rates of billing fraud, clinics and hospitals are forced to adopt ethical billing processes otherwise they would face legal consequences.

If you too want to stay away from future problems, here we have listed multiple illegal dental billing activities that should be your priority to not get into.

  1. Duplicate Billing Invoicing

bill amount

Double billing is the most common and alarming unethical billing practice which means billing a patient for the same medical treatment twice.

This way you as a healthcare provider are charging for one service multiple times which is surely going to impact the patient’s financial condition.

Legal consequences: By conducting double billing, you will be under the radar of the False Claims Act (FCA) and could be fined up to three times more than what damage you cost to the patient.

Penalties of about $11,463 to $23,331 will also come your way under the act of FCA.

  1. Charging for Unprovided Services

Many providers due to excessive workload charge falsely to the patient, sometimes unintentionally but mostly intentionally.

This means you are billing the patient for the dental service you didn’t even provide. 

Legal consequences: FCA controls this billing practice as well but in this case, legal results are more severe than you think. 

You could be jailed for 10 years per offense along with some hefty fines and penalties.

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  1. Upcoding

Upcoding may be the most known fraud among multiple unethical dental billing practices. 

This is basically the practice of charging more dental service fees than reasonable to patients through bills or insurance companies through claims. 

However, upcoding is difficult to identify because healthcare facilities add more codes and use clever tactics to show that the bill is justified and for the same services that were rendered.

Legal consequences: Upcoding may lead to heavy fines and severe criminal charges along with penalties of about triple the damage.

  1. Tampering With Claims

person working on medical claim

A claim application is one that lists dental treatment given to the patient and then sent to the insurance companies to bill those treatments.

But some providers modify claims i.e. they may add more codes or alter dental services to receive excessive payment.

However, this process is conducted at the time of claim preparation but due to modification, it may lead to errors in the claim which may cause denial.

So eventually, an insurance payer may reject the payment. Thus, the patient will be responsible for expensive bills due to your mistake.

Legal consequences: Along with usual civil and criminal penalties, you will be excused from Medicare and Medicaid programs as a punishment. You will never be able to bill them again.

Altering claims may also lead to imprisonment and substantial fines.

  1. False Documentation

This is another illegal dental billing practice in which in patient documents, false charges are added.

It doesn’t have to do with services provided or not. Instead, false documentation means listing more expensive treatments than the one given.

For example, if you have received dental treatment of only tooth filling, if the provider has conducted document misrepresentation then they will add service codes for tooth exchange instead.

As insurance payers don’t communicate with patients most of the time, they will have to make the payment for financial charges, impacting patients’ coverage.

Legal consequences: Under the law of FCA, you may be fined civil penalties of up to $11,463 to $23,331 per claim along with the exclusion from the Federal Healthcare Program.

10 years in prison may also be sentenced in severe cases.

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  1. Insufficient Insurance Verification

Eligibility verification is the first and foremost crucial step of medical billing. Here dentists contact insurance companies and confirm the coverage of services a patient is about to receive. It helps patients anticipate charges they owe other than insurance coverage.

But as we are talking about unethical dental billing practices, this process is altered too. 

Many times, dentists do not keep in mind the insurance coverage limit. They just perform the services that aren’t insured and thus patients have to bear heavy bills and more than what they have expected.

They also perform some procedures that are not medically required but to receive more payment through deceptive ways, they perform unnecessary treatments on patients and bill insurance companies.

This results in both the patient’s dental and financial health damage.

Legal consequences: This unethical billing activity is controlled by the Health Care Fraud Statute Act. You may be fined with heavy penalties and may also be obliged to repay fraudulent claims.

Exclusion from Medicaid and Medicare programs is also a potential danger in this situation.

  1. Using Another Patient’s Insurance for Claims

medical identity theft

Lastly, a few dentists become more clever and send your claim by filling in the insurance information of another patient. Let’s break it down.

Imagine you received a minor dental treatment costing low insurance charges. However, your provider fills in the claim form using the information of another patient who received an expensive treatment. This makes insurance companies pay more but in reality, they are obliged to pay less because of the minor treatment.

Legal consequences: You may be imprisoned for up to 15 years for identity theft. Additional penalties and fines under Health Care Fraud Statute law can also be enacted.

Key Takeaways: How to Avoid Unethical Dental Billing Practices

As we mentioned these unethical dental billing practices along with their legal consequences, you wouldn’t want to be one of these because you don’t want to hurt your reputation.

But sometimes unintentional mistakes happen, which lead to severe issues like regulatory authorities reaching out to you or your dental facility being sued by patients.

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    To avoid these obstacles in the future, follow these advices to perform accurate billing:

    • Audit billing records often to find and stop fraud or inaccuracies.
    • Ensure that staff members communicate and document in a clear and correct manner.
    • Install billing software with features that guarantee accuracy and identify duplicate claims.
    • Check to make sure the patient received all of the dental services that were billed.
    • Make sure that every procedure has a precise code, and that staff members receive frequent training on proper coding techniques.
    • Patients should be made fully aware of their insurance coverage and any possible out-of-pocket expenses. 

    So make your billing error-free and always stay the favorite of healthcare laws and patients as well.