If your boss asked you to hold a weapon while they threaten someone and took their wallet, you would never agree to participate in that kind of activity. However, when an employer asks their billing or records specialist to make some minor changes to the paperwork they submit or process, employees may not think much of doing exactly as requested.
Even if the employee suspects that the changes might relate to insurance billing fraud, they might think of billing fraud as a victimless crime. Unlike a robbery where someone winds up traumatized and losing out on something they personally value because of the crime, billing fraud just means that a faceless corporation or the government loses out on a little bit of money.
You might not think that making changes to billing statements or tweaking the records really matters in the grand scheme of things. It may not seem nearly as serious as robbing someone, but it can actually result in federal criminal prosecution. Even if you never directly receive funds because of the fraud, you could still wind up charged without profiting from the offense.
There are a number of ways in which your employer could potentially engage in fraudulent insurance billing practices. For example, they might have you look up procedure codes in order to bill for a more expensive procedure than the actual treatment administered by the physician.
They might have you round up the amount of time a professional spends with a patient to bill for more than they should. They might even have you take a service usually paired with something else at a discounted rate and charge for those services separately in order to maximize what they can bill.
On the surface, those practices may seem negligible or even like smart business. However, they constitute billing fraud. If a patient or someone involved in the claims process becomes suspicious about the practices at your office, it’s possible that everyone involved could wind up facing federal criminal charges. Particularly if the insurance involved is a government program, like Medicaid or Medicare, the risk of federal prosecution is a very real concern.