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Billing for services not rendered or not documented
|
Billing outpatient services for inpatient stays (72 hour rule)
|
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Providing medically unnecessary services
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Teaching physician and resident/supervision requirements
|
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Billing for services rendered but not covered
|
Duplicate or erroneous billing
|
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Upcoding
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False cost reports
|
“DRG creep”
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Billing for discharges in lieu of transfer
|
| Unbundling |
Contractual Agreements between Hospitals and Physician not grounded in fair market valuation
|
| Patients’ freedom of choice |
Hospital incentives that violate anti-kickback laws and regulations
|
Credit balances -- failing to refund
|
Joint ventures
|
| Stark self-referral law violations |
Knowing failure to provide covered services or necessary care to HMO members
|
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Patient “dumping”
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|
