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opticXpress is an optometric billing company that provides a clearinghouse, billing service and software strictly for optometrists.
Tuesday, January 24, 2012
Optometric Billing-Insurance Fraud
One of our biggest request from potential clients is for us to do things that we believe might be construed as "inusrance fraud". It is our goal as optometric medical billers to provide the best possible service and help optometrists recoup money from insurance as best as possible, but not un-ethically. Take a look at what happened to this Caldwell, ID optometrist:
"A federal grand jury has charged a Caldwell optometrist with swindling more than $1 million from health care benefit programs.
Christopher Card, 59, of Caldwell, allegedly lied and submitted false material to several programs, especially to Medicaid and Medicare. He dishonestly billed the programs, the indictment says, for false diagnoses, including glaucoma, color blindness, tension headaches and treatment of eye injuries.
This went on from as early as Sept. 1993 to Aug. 2010, the indictment claims.
The indictment further alleges that — although Card treated only 3.9 percent of Idaho’s Medicaid clients from Jan. 1, 2004 to May 8, 2009 — he reported diagnosing 99 percent of all acquired color deficiency cases among Idaho Medicaid patients. He also diagnosed 92 percent of all glaucomatous atrophy (optic cupping) cases and 86 percent of all chronic angle closure glaucoma cases.
It is also alleged that, in 2008, Card learned about the federal investigation, abruptly stopped submitting claims for glaucoma-related services and began billing for a variety of new diagnoses."
(You can read the article in its entirety by clicking here)
Apparently this Optometrist can see up to 10 years in prision, a fine of $250,000 and an additional 3 years of supervision after his release! It just doesn't pay to bill insurance incorrectly, NO MATTER HOW CROOKED YOU MAY THINK THE INSURANCE PLAN MAY BE!
By hiring a good and knowledgeable optometric billing expert, however, you don't have to worry about finding creative methods to bill insurance. For example, the industry average for collection from insurance is 70% while the average for collection using in-house staff is closer to 60%. opticXpress averages 75% collection rates from insurance. Did you realize that even this doctor and all his fraudulent billing yielded him only about 60-65% collection rates based on those statistics and HE USED FRAUD TO ACCOMPLISH THIS?!
"A federal grand jury has charged a Caldwell optometrist with swindling more than $1 million from health care benefit programs.
Christopher Card, 59, of Caldwell, allegedly lied and submitted false material to several programs, especially to Medicaid and Medicare. He dishonestly billed the programs, the indictment says, for false diagnoses, including glaucoma, color blindness, tension headaches and treatment of eye injuries.
This went on from as early as Sept. 1993 to Aug. 2010, the indictment claims.
The indictment further alleges that — although Card treated only 3.9 percent of Idaho’s Medicaid clients from Jan. 1, 2004 to May 8, 2009 — he reported diagnosing 99 percent of all acquired color deficiency cases among Idaho Medicaid patients. He also diagnosed 92 percent of all glaucomatous atrophy (optic cupping) cases and 86 percent of all chronic angle closure glaucoma cases.
It is also alleged that, in 2008, Card learned about the federal investigation, abruptly stopped submitting claims for glaucoma-related services and began billing for a variety of new diagnoses."
(You can read the article in its entirety by clicking here)
Apparently this Optometrist can see up to 10 years in prision, a fine of $250,000 and an additional 3 years of supervision after his release! It just doesn't pay to bill insurance incorrectly, NO MATTER HOW CROOKED YOU MAY THINK THE INSURANCE PLAN MAY BE!
By hiring a good and knowledgeable optometric billing expert, however, you don't have to worry about finding creative methods to bill insurance. For example, the industry average for collection from insurance is 70% while the average for collection using in-house staff is closer to 60%. opticXpress averages 75% collection rates from insurance. Did you realize that even this doctor and all his fraudulent billing yielded him only about 60-65% collection rates based on those statistics and HE USED FRAUD TO ACCOMPLISH THIS?!
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