Question

OIG identified risk areas that should be specifically addressed. Out of the following risk areas, choose one and identify how you would address this in the compliance plan.

A. Upcoding

B. Duplicate billing

C. Billing for items or services not actually rendered

Answer 1

C. Billing for items or services not actually rendered: It is a fraudulent practice that is most commonly followed, there can be two possible scenarios here. One is billing for services other than what is provided, second is billing for services which is not provided at all. Both of which are fraudulent & unethical processes.

This practice can be avoided by creating purchase orders for each vendor, while making every purchase the billing is done to the respective orders. By this as & when the invoice is created it is matched with each purchase order & the respective vendors. Before releasing the payment if the invoice is not matched, payment will not be cleared.