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Wednesday, July 17, 2024

5 Unreliable Medical Billing Techniques in 2023

Medical billing specialists are trusted by healthcare providers to uphold the law and the highest standards of morality and honesty. Medical professionals lose time and money due to billing mistakes that could have been better used in patient care and treatment.

Medical billing experts generally behave ethically. However, it’s prudent to take into account how damaging unethical medical billing practices are to the sector as a whole. Unless it was done on purpose, this goes beyond a mistake or an inadvertent code.

Consider a patient who must wade through medical billing codes that have been applied incorrectly or unethically. The fact that these individuals may have just returned from a stressful trip to the doctor or hospital is insufficient. Now they also need to overcome obstacles in order to fight back against unfair or inaccurate billing practices.

Medical staff members, health insurance providers, and medical institutions all make an effort to spot medical procedure billing fraud. Fraud in the medical field costs money; worse, it may result in fatalities. How many people who are ill or injured have put off going to the doctor’s office out of concern that they won’t be treated fairly?

We are all harmed by billing fraud. Patients must feel confident that a medical biller is working on their submitted claim with them and their best interests in mind. There are a few helpful internet resources on handling circumstances involving medical billing issues for our regular blog readers.

Reporting Immoral Conduct in Healthcare

Fortunately, the medical field largely self-regulates. Physicians who think a colleague is unethical or incompetent generally have a duty to inform clinical authorities. If there is an imminent hazard to patients, they may also report the incident(s) to the state licensing board or state medical society. Protecting the health and safety of the patient should always come first for a doctor.

But what if you, the patient, think your doctor or other healthcare provider has engaged in unethical behavior? If you believe you have been treated unfairly by a healthcare professional or facility, you should file a complaint. Doing so may stop the unfair treatment, enhance the standard of care overall, or at the very least, resolve any misunderstandings.

Contacting the Washington State Department of Health will allow you to lodge a complaint there. You can send an email to HSQA.csc@doh.wa.gov, phone the Health Systems Quality Assurance (HSQA) customer service line at (360) 236-4700, or complete an online form.

There are no time restrictions associated with these complaints, although it is advised that you report this behavior as soon as you can. If an inquiry reveals any wrongdoing on the part of the healthcare professional, the case will be presented to a panel of DOH or commission members for approval to impose discipline.

This could take the form of penalties, counseling, restrictions on the practise, retraining, license revocation, or other measures. If the institution is at fault, no fines or other sanctions will be imposed, but it will still be required to make any transgressions that are against the law right.

5 Immoral Medical Billing Techniques


This is a type of overbilling or up charging. When a patient gets charged more than is necessary for a certain service, it happens. According to NerdWallet, a hospital could upcode a patient’s procedure to a CPT code with a higher value, raising the patient’s medical bill. For instance, you might have only received the most basic emergency department care while receiving the most expensive charge. You should request that your healthcare provider promptly reverse this fraudulent and illegal charge.

overlapping costs.

It is similar to No. 1 in that it is a type of overbilling. This is getting charged twice for the same procedure, as the name suggests. If you’ve ever missed something in a medical bill or benefit explanation, you may understand why this might be a common strategy used to extract more money from a patient.

Phantom attacks.

This indicates that a patient has been charged for services that were never actually provided, rather than inaccurate services.


The separation of expenses that ought to have been billed under the same procedure code is known as unbundling, according to NerdWallet. Unless you’re a qualified medical bill coder, it can be difficult to spot this kind of error, but if you suspect one on your bill, you can consult the Centers for Medicare and Medicaid Services’ National Correct Coding Initiative.

incorrect amounts

A dishonest medical biller could overcharge a patient by exaggerating the total number of products or drugs that they got.

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