LanceCorpsman
Forum Lieutenant
- 120
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- 18
Hypothetically...
You write a chart for a run for an elderly "fall" victim that rolled off of his bed. The pt seems to be uninjured, the pt has no complaints. The pt is atraumatic upon physical examination. The pt is on Coumadin. What should be just a lift assist turns into a transport because the wife of the patient is insisting him to go to the ER to get seen.
Your report states exactly what happened, you know the ambulance won't get reimbursed from medicare because of the circumstances.
However, a few weeks later, you see that the agency got payed by medicare for that call. It turns out the billing agent turned it into a trauma system activation and billed for it. So the PCR that i wrote and signed was altered in order to get paid (there is a box that states is I activated trauma or not, i checked no, but the one turned into medicare was checked yes..
Is this fraud? If so, should you report it? To whom?
You write a chart for a run for an elderly "fall" victim that rolled off of his bed. The pt seems to be uninjured, the pt has no complaints. The pt is atraumatic upon physical examination. The pt is on Coumadin. What should be just a lift assist turns into a transport because the wife of the patient is insisting him to go to the ER to get seen.
Your report states exactly what happened, you know the ambulance won't get reimbursed from medicare because of the circumstances.
However, a few weeks later, you see that the agency got payed by medicare for that call. It turns out the billing agent turned it into a trauma system activation and billed for it. So the PCR that i wrote and signed was altered in order to get paid (there is a box that states is I activated trauma or not, i checked no, but the one turned into medicare was checked yes..
Is this fraud? If so, should you report it? To whom?