As cancer cases rise, fraudulent billing practices for cancer treatments continue to plague the healthcare industry. Organizations can take steps to protect themselves from fines and penalties by using risk-based auditing software to identify coding problems early on.
(Brookfield, WI) December 18, 2017—According to the latest statistics, over 1.6 million new cases of cancer are diagnosed in the United States each year.(1) As the number of cancer cases grows, treatments for cancer, including chemotherapy, radiation therapy and surgery, are utilized often at healthcare centers nationwide. But in some healthcare facilities, problems with the medical coding process lead to overbilling for cancer drugs and treatment services, having disastrous consequences for providers, patients, and the healthcare system as a whole. The solution, says healthcare support and management industry leader Fi-Med Management, is the application of risk-based auditing software—such as REVEAL/md—in the daily functions of healthcare centers.
Called “upcoding,” fraudulent billing activity occurs when hospitals use incorrect medical codes to charge third-party payers for services or treatments that were not given. Even though patients may not immediately realize the consequences of upcoding, the effects of overbilling are eventually passed on to consumers through higher co-pays and co-insurance rates.
In some cases, certain hospitals use price manipulation to overbill for treatments such as chemotherapy, which costs insurance companies and governmental agencies such as Medicare millions of dollars in payouts.(2) The end result is higher insurance premiums and larger co-pays for healthcare consumers. But hospitals and healthcare providers are also affected—healthcare facilities stand to lose millions in fines and penalties if fraudulent billing practices are identified by healthcare auditors.(3) Individual practitioners can be sued, sanctioned or have their medical licenses revoked.
Adrian Velasquez, president, CEO and co-founder of Fi-Med, says, “Upcoding is too big a risk for healthcare organizations to take. In many cases, healthcare system administration may not even be aware that this fraudulent activity is taking place. That’s why it’s critical for organizations to utilize risk-based auditing software to easily identify problems with coding early on; in this manner, steps can be taken to correct issues before there’s any fallout.”
About Fi-Med (www.fimed.com)
Since 1993, Fi-Med has been working alongside healthcare providers and networks to maximize revenue and reduce risk—from catching billing errors to providing high-level safeguards against compliance risk. Fi-Med is a healthcare-technology company helping to disrupt the status quo of the increasing burden of government compliance on hospitals and hospital systems. As a leader in the healthcare support and management industry, Fi-Med provides billing, receivables management, credentialing, lockbox, and other financial management and reporting services to physicians, labs and medical centers nationwide. Its strong reputation for maximizing revenue and reducing risk for hundreds of hospitals, labs, private physicians and healthcare networks is the result of the technology tools that it has
created—a 360-degree understanding of healthcare compliance, chronic care management, and revenue cycle management.
REVEAL/md is Fi-Med’s keystone product, empowering healthcare providers’ compliance departments to proactively manage physician part B audits of documentation and coding. For more information, visit www.fimed.com.
About Adrian Velasquez
Armed with an extraordinarily successful career in the healthcare industry, Adrian E. Velasquez, president, CEO and co-founder of Fi-med, has blazed new trails, taken risks, defied the odds, and in 1993 partnered with Christine Krause in forming Fi-Med Management, Inc. Their mission: to bring business acumen and compliance expertise to healthcare providers throughout the United States.
Prior to his work at Fi-Med, Adrian worked with healthcare providers across the country, mastering all areas of business function and management for medical organizations of all sizes. His previous experience as a system administrator, executive director of a 54-provider medical group, and healthcare consultant from New York to California formed the foundation that he harnesses today for Fi-Med clients.
Among his many accolades, Adrian won the Small Business Person of the Year Award in 2007 for the state of Wisconsin and represented Wisconsin on the national stage.
Fi-Med has been working alongside healthcare providers and networks to maximize revenue and reduce risk—from catching billing errors to providing high-level safeguards against compliance risk. We’ve grown exponentially over the last 24 years, becoming trusted experts in the fields of financial healthcare management, compliance and risk assessment, and chronic care management.
1. Cancer Statistics. National Cancer Institute. https://www.cancer.gov/about-cancer/understanding/statistics
2. Highmark sues UPMC for cancer treatment “overbilling”. Pittsburg Post-Gazette. http://www.post-gazette.com/business/2014/09/03/Highmark-sues-UPMC-over-cancer-treatment-overbilling/stories/201409030202
3. UPMC Loses Appeal Bid in $300M Overbilling Arbitration Row. Law360. https://www.law360.com/articles/948292/upmc-loses-appeal-bid-in-300m-overbilling-arbitration-row