Medicare Compliance & Reimbursement

Tips for action when someone makes unauthorized revisions.

Physicians who suspect that someone in their practice - either a doctor or other staff person - has altered documentation incorrectly shouldn't panic, but they should have a course of action for dealing for such situations.

Attorneys offer the following suggestions for physicians coping with altered documentation in their practices:

1. Call an attorney. The country is full of False Claims Act attorneys who will be happy to help doctors with this problem, says Stephen Meagher, a San Francisco attorney and former federal prosecutor.
 
2. Self-disclose as quickly as possible. The HHS Office of Inspector General and Medicare carriers all have fraud hotlines, notes Meagher.

3. Figure out who might have altered the records. The people who have had access to the records in question are usually apparent. "Most of the time, in our experience, it's not that difficult to figure out who was ... involved in altering records," says Meagher. "The line of custody or possession is fairly evident."

4. Be prepared to leave the practice if need be. A physician that suspects a physician or administrator is systematically altering records to raise billing amounts should walk away as quickly as possible, says attorney Joan Roediger with Obermayer Maxwell & Hippel in Philadelphia.

5. Consider payment. A physician should determine whether the documentation changes affected the claim's payment amount. "If you had an alteration and the purpose of the alteration was to correct mistaken info, that certainly wouldn't be problematic and wouldn't trigger any disclosure duty," says attorney Robert Salcido with Akin Gump Strauss Hauer & Feld in Washington. But if the change to the records raised the reimbursement level, there's a problem.