Health Care:

Consultants' Billing Advice May Lead to Improperly Paid Insurance Claims

GAO-01-899T: Published: Jun 27, 2001. Publicly Released: Jun 27, 2001.

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This testimony discusses the results of GAO's investigation of health care billing consultants whose seminars and workshops advise health care providers on how to boost revenue and avoid audits. Consultants at two workshops that GAO attended provided in-depth discussions of regulations on billing for health care services and compliance with health care laws and regulations. Some of this advice was inconsistent with federal law and guidance provided by the Department of Health and Human Services' Office of Inspector General. Such advice could result in violations of both civil and criminal statutes. Some consultants urged health care providers to not report or refund overpayments from insurance carriers after they were discovered. The consultants also encouraged the performance of unnecessary tests and procedures to generate documentation that would support bills for evaluation and management services at a higher level of complexity than actually confronted during patients' office visits. This testimony summarizes a June report (GAO-01-818).

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