Part B News Interviews Kaiser about Billing Fraud Incident

Jeff Kaiser spoke to Part B News for the article, “Third-Party Biller Fraud May Hook Your Practice, Unless You Protect Yourself.”

The article discusses a case against a third-party biller who was charged with healthcare fraud, which was settled in October by the U.S. Attorney’s Office for the Northern District of New York.

Jeff noted that the flat fee the biller charged to the healthcare providers could present an opportunity to commit fraud. “If a biller charges a percentage of collections… there would be an obvious financial motive for the biller to
upcode the claims and increase the reimbursement amounts,” Jeff said. However, “if the biller is receiving a fixed monthly fee… it is still possible that the biller could falsify claims submissions and then — particularly if the biller was also
performing management and administrative services, as in the cited case — keep the ‘delta’ between the inflated reimbursement amounts and the true reimbursement amounts, returning only the lower amount to the provider.”