Avoid Fraud and Abuse Charges With Careful Gainsharing

Gainsharing may be beneficial for your bottom line in medical billing, but it raises a lot of suspicion for the Centers for Medicare & Medicaid Services. The HHR Office of Inspector General believes gainsharing can be questionable because it can violate anti-kickback policy, and the Stark Law. The Office of Inspector General states there are three fraud safeguards to use when using gainsharing medical billing.

First, when utilizing gainsharing arrangements, you should be sure your organization promotes accountability. If you are accountable for your policies and medical billing procedures, you look a lot less suspicious. Another gainsharing safeguard to use is to limit any payment that could change referral patterns. Finally, the third medical billing gainsharing safeguard is to implement sufficient quality controls. The more accurate your staff are, the less questioning eyebrows you will raise.

It is always important to avoid fraud and abuse allegations or charges. Not only is this illegal, but simple allegations can hurt your practice and lower medical billing reimbursement substantially. If you decide to use gainsharing, be sure to use these agreements with care. They come very close to violating certain statutes and sometimes make your practice appear greedy and dishonest.

As long as you make sure you are accountable for your actions, are limiting payments that change referral patterns, and are implementing quality controls, then you will be free of fraud suspicion. Medical billing firms can help you become compliant with these regulations. These firms are very versed on policies and procedures necessary for correct medical billing. If you would like to ensure an honest, profitable practice, hiring a medical billing company is a step in the right direction. If your decision is to gainshare, be sure to implement all medical billing safeguards to protect your practice.

View all Articles by: Melissa C. - OMG, LLC. CEO