Don't Be A Target For Law Enforcement,

Unscrupulous Insurance Companies, Medicare, And State Boards.

Enforcement of medical billing compliance issues is on the rise. Audits of healthcare providers are on the rise. Doctors are easy money for insurance companies and the government. We all know colleagues who have been audited and ultimately had to pay the insurance company and/or been fined by authorities. Some have lost their licenses and some have even been sent to jail. The federal government recoups $8 for every $1 it spends on enforcement. That figure is even greater for private health insurance companies’ audits. The primary areas investigated during an audit include illegal discounts and anti-kickback violations. Don’t make yourself an easy target!

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  • Do your patients ever get upset having to pay an additional fee to join some network so they can pay less? Doesn’t that defeat the purpose?
  • As providers, we have enough of an issue placing value on our services, why burden your patient with the cost of joining a discount medical plan.
  • Offer legally discounted services without accusations of illegal inducements, dual fee schedules or improper time of service discounts.
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Patient Options is free for patients, and can help cover you against illegal actions for dual fee schedules, anti-kickback accusations, inducement violations, time of service discounts, civil monetary penalties and false claims acts.

Patient Options DMCO can help protect you from these following things:

Time of Service

The prompt pay discount is legal in many states, but many times it is a front for a dual fee schedule  (illegal) because it is not implemented correctly and not truly a time of service discount.  Many times the discounts are excessive and not truly representative of the savings incurred by "prompt pay."

Anti Kickback Laws

Anti kick back laws were established in 1972 to prohibit remuneration (kickbacks) for services reimbursable under federal healthcare programs.  Many states have similar laws in place for private payors  as well.  

Civil Monetary Penalties

Enacted in 1981.  CMS is responsible for enforcing non-fraudulent aspects and the OIG is responsible for enforcing CMPs that involve fraud or false representations.  CMPs can add up to $10,000 per item or service!! 

False Claims Act

False claims act violations happen in normal everyday practice unknowingly by many providers. Examples of such violations include, up coding, down coding, unbundling codes, kickbacks, and improperly waiving coinsurance or deductibles.

Dual Fee Schedules

It is in violation of most private insurance agreements to have a different rate for cash patients vs. insurance patients.  Many PIP/Medpay carriers use this as a reason to discount bills as well.  This is a common theme for board complaints and fines.

Inducement Violations

Section 1128A(a)(5) of the Social Security Act prohibits a provider from offering a Medicare beneficiary any remuneration that  should likely influence the beneficiary’s selection of a particular provider of payable items or services. Violations may subject the provider to civil monetary penalties o up to $10,000 for each wrongful act.  

Patient Options works for all types of healthcare practitioners:

General Practitioners - Chiropractors - Medical doctors - Dentists - Physical Therapists - Massage Therapists - Podiatrists - Osteopaths - Naturopaths - Surgeons - Urologist - Rheumatologists - Radiologists - Psychiatrists - Podiatrists - Plastic Surgeons - Physiologists - Pediatricians - ENT Specialists - Orthopedic Surgeons - Oncologists - Obstetricians - Neurosurgeons - Neurologists - Neonatologists - Microbiologists - Internal Medicine Specialists - Gynecologists - Endocrinologists -Dermatologists - Cardiologists - Anesthesiologists - Allergists - Audiologists

Check out what our clients have to say about our services!

Doctor Rebecca discusses Patient Options

Takes the burden from the patients 

-Dr. Rebecca

Patient Options protects providers

Great for patients

-Jenn

Patient Options in a doctor's office at a medical center

Our office loves this service

-Kelli

Patient Options at the doctor's office

It's Awesome

-Dr. P

Patient Options helps patients and doctors navigatr regulations

It is a fantastic deal for us and the patient

-Dr. C

Patient Options Man

Patient Options is truly easy, simple, and helpful

-Dr. B

We provide help and compliance protection against accusations from your state's board for dual fee schedules, anti-kickback accusations, time of service discounts, inducement violations, civil monetary penalties, and false claims act accusations.  

AI in healthcare fraud detection is here! Protect yourself with Patient Options!

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It is here folks! Machine learning and AI are going to be used in a proactive way to detect the fraud in the healthcare market. The investigators will be well down the trail of knowing who to audit before they even send the letter they will have a pretty strong idea of what they will…

What the claim investigation market is doing

By Tony Stonem | October 29, 2018

A quick way to see what we are going to deal with as providers down the road is to look into what the healthcare fraud industry’s latest advances. Insight partners has released a report on the future of the fraud detection industry in their report, “Healthcare Fraud Detection Market Size and Key Trends in terms…

The most basic case of fraud.

By Tony Stonem | October 17, 2018

Healthcare fraud happens all the time but the most classic case of fraud is charging for something and not performing the service. Let’s look at the at the recent arraignment of Primera healthcare executives in Atlanta Georgia. Tim Darnell from the ATL based paper patch writes in his article, “Primera Medical Group Execs Charged With…

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