Am I liable for overbilling?

[ukrkoz]

What is the name of your state? WA

Not really sure where to ask, so I'll try here.
I work in a medical office dealing with DME, durable medical equipment. It's a small office.
As of the last year or so, owners, divorced man and wife, started pushing towards overbilling insurances, sometimes, for services not provided.
As is, we, 2 practitioners, are supposed to code for our services, time and materials used.
We are provided with "templates" and "strongly encouraged" to use them for coding, as they "maximize profit". We had many cases, when we removed some codes as not appropriate, just to have it added back later by final biller.
As practitioners, we are not billing insurances or patients, that is done by owners.
But, as we do code our services and devices provided - in case of audit, how much are we, the practitioners, liable for potentially fraudulent coding? Couldn't company owner simply say - Not me, it's Johnny, he coded, I trusted him!
Thank you

 

[AlmostThere]

This would be a good time to say nothing and find an attorney.

 

[ukrkoz]

Appreciate the suggestion, but does it mean that yes, there's potential liability?

 

[Zigner]

Appreciate the suggestion, but does it mean that yes, there's potential liability?

There is potential criminal liability, yes. Insurance fraud is not taken lightly. I would also suggest that you start looking for another firm to work with/for.

 

[AlmostThere]

A company is responsible for the actions of its agents. So it may not be as easy as saying "Not me, it's Johnny, he coded, I trusted him."

https://www.law.cornell.edu/wex/respondeat_superior#:~:text=Under the doctrine of respondeat,an employee or an agent.

 

[adjusterjack]

Couldn't company owner simply say - Not me, it's Johnny, he coded, I trusted him!

You do what's right and document it. If somebody changes it later, you have a defense, if needed.

 

[ukrkoz]

I see.
Of course, it's not as easy, as I'm 69, work in the niche field and changing job is almost impossible without hopping states and I'm well rooted.
Also, I see 2 opinions.
1. Yes, you are liable, even though you're not the one who signs billing
2. No, you are not liable, company is. Owner.


Retirement is out of question so far.

 

[Zigner]

2. No, you are not liable, company is. Owner.

No, the company may also be liable.

 

[LdiJ]

I see.
Of course, it's not as easy, as I'm 69, work in the niche field and changing job is almost impossible without hopping states and I'm well rooted.
Also, I see 2 opinions.
1. Yes, you are liable, even though you're not the one who signs billing
2. No, you are not liable, company is. Owner.


Retirement is out of question so far.

If you feel that you have no viable options then at a minimum you need to do what Adjuster Jack suggested and document what you actually coded (and keep copies) so that you have some defense that you were not the one committing fraud.

 

[ukrkoz]

No, the company may also be liable.

I see.
Basically, whoever is coding services is liable under this paradigm, correct? And then, CO may be liable, as general supervisor?
Even though he openly directed us to bill for things, we are not comfortable with or, simply, were not done?

 

[quincy]

I see.
Basically, whoever is coding services is liable under this paradigm, correct? And then, CO may be liable, as general supervisor?
Even though he openly directed us to bill for things, we are not comfortable with or, simply, were not done?

What you should have done is become a whistleblower and report your employer’s fraudulent over billing. Now you need an attorney.

 

[ukrkoz]

Noted.
Thank you all.

 

[quincy]

Noted.
Thank you all.

Good luck.

 

[Zigner]

What you should have done is become a whistleblower and report your employer’s fraudulent over billing. Now you need an attorney.

I don't think there's any reason why the OP can't still become a whistleblower.

 

[quincy]

I don't think there's any reason why the OP can't still become a whistleblower.

You’re right. I thought s/he was already caught overbilling. It is better to report the employer now rather than have to explain later why s/he didn’t.