Running a healthcare practice involves many responsibilities beyond caring for patients. As a practice owner, you have to protect your business’s integrity while upholding strict compliance to government programs like Medicare and Medicaid.
This raises a critical question: can your practice face liability for billing fraud committed by your staff?
The responsibility of practice owners for employees
Medical practice owners can get in trouble for fraudulent billing done by their employees, even if they didn’t know about it.
The government uses several legal ideas to hold healthcare practices responsible for employee actions. One legal doctrine called “respondeat superior” means employers are legally responsible for what employees do during their job.
Federal investigators look for signs that you didn’t properly watch over your billing practices. They might say you were negligent if you failed to properly check employees’ backgrounds or monitor their work.
Compliance measures show good faith
Creating a strong compliance program helps protect your practice from being blamed for employee fraud. Here are several key steps to take:
- Have clear written standards: Create easy-to-understand billing policies that all employees must read and sign
- Designate a compliance officer: Assign one person to oversee compliance who reports directly to leadership
- Train everyone regularly: Teach staff about proper billing and how to prevent fraud
- Establish reporting procedures: Make it possible for staff to anonymously report concerns
- Monitor and audit: Regularly review billing records to make sure they’re accurate
- Fix problems quickly: Investigate and correct issues as soon as you find them
- Screen employees: Check government exclusion lists before hiring people
- Document everything: Maintain records of all your compliance activities
Strong compliance measures show the government you’re trying to do the right thing if questions come up about your employees.
Protecting your practice requires vigilance
Your medical practice’s reputation depends on honest billing at every level. Remember that investigators won’t just look at the individual employee who did something wrong. They’ll also check if your practice made it easy for fraud to happen.
By investing time and resources in prevention now, you protect yourself from the serious financial and professional damage that can result from employee billing fraud. If you still face fraud accusations, an experienced attorney can help you document the measures you took and create a strong defense to protect yourself and your practice.