Billing Consultants May Offer Fool’s Gold, OIG Warns Physicians

Billing Consultants May Offer Fool’s Gold, OIG Warns Physicians

One of the top revenue enhancement strategies for medical groups today is raising the coding of services performed, but groups should be sure that the new codes are correct and that they are not led astray by billing consultants advising them to claim more money than is justified the HHS Office of Inspector General warns.

OIG warned physicians and other providers about potentially unscrupulous business consultants in a re cent special advisory bulletin. Among six questionable actions flagged by the agency were:

(1) On a buy in or out to or from a medical group, a valuation consultant assuring a client that its appraisal of a physician practice will yield the number the client wants, regardless of the actual value of the practice.

(2) A billing consultant promising a client that it will produce a specific dollar or percentage increase in the client’s Medicare reimbursements especially when the consultant’s fees are a percentage of the hike in reimbursement.

(3) A reimbursement specialist suggesting that a client use inappropriate billing codes in order to raise reimbursement (“upcoding”), and suggesting the creation of deceptive documentation or describing other ways to avoid detection.

(4) A consultant encouraging a client to modify or customize a routine medical supply or device in an in significant manner, in order to justify billing the item as a specialized one that generates higher reimbursement.

(5) A consultant promising to increase Medicare revenues for laboratory services by showing clients how to disguise double billings or bill for unnecessary services.

(6) A compliance consultant claiming it is recommended by GIG, or advising a client not to cooperate with payer audits.

GIG noted that most health care business consult ants are ethical and perform useful services.

To see the bulletin, go to our Web site,, then click Compliance, HCFA/IG library, OIG advisory opinions, OIG home page, fraud alerts and bulletins, special advisory bulletins, and practices of business consultants.

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