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Dermatology Medical Practice Accused of Overbilling

March 17, 2016

Dermatology_overbilling.jpgHow important is your letter grade from the BBB (Better Business Bureau) or online review? According to online statistics, 71% of consumers consider the BBB rating before buying goods or services from a business. That’s why it’s more than a little surprising that a dermatology medical practice shrugged off its F grade and accompanying consumer warning. The practice has clinics in seven states in addition to main clinic in the Atlanta location, several of which have outstanding complaints. 

So what’s behind the failing grade and consumer warning? Mike Boynton of the Metro Atlanta BBB says there are some 158 active complaints against the one of the locations alone, none of which have been answered by the office or their staff. But important thing is nearly all of the complaints revolve around medical billing issues, specifically over billing patients for services already covered by the patient’s insurance carrier or double billing co-pays and coinsurance amounts. 

In fact, in a law suit lodged against another family dermatology practice in Maryland, a doctor employed by the practice alleged that not only did the company overcharge and double bill its patients, it refused to answer patient phone calls and emails. The doctor testified that the practice’s billing department voice mailbox was never emptied so that patients could not leave messages. Emails went unread and unanswered. So the medical practice ultimately settled the case out of court.

Download: Dermatology Practice Turn Around Case Study

A reporter for a local Atlanta news station managed to interview the said physician, who seemed unconcerned about the complaints, warning, and failing BBB grade. “That’s not what I’d like but some patients owe money,” she said, insisting that the issue wasn’t the quality of the service provided to patients. Asked specifically about the F grade, physician replied, “It’s okay. So does Google. So does Walmart.” These claims were proven untrue, as both companies have A ratings by the BBB. 

An article in Dermatology Times online edition describes the increased attention and focus on dermatologists as the subject of RAC reviews and even full blown audits from the commercial carriers such as BCBS (Blue Cross Blue Shield) and United Healthcare Group in addition to Medicare. 

Dr. Allan Wirtzer, a dermatologist from Sherman Oaks, California, says that any procedure that is high volume and high dollar, such as Mohs surgeries, are being targeted by the government and major carriers for increased scrutiny. Other areas potentially triggering audit or investigation include “incident to” services provided to Medicare beneficiaries by non-physician personnel when there is no physician on the premises. 

Biopsies are also increasingly targeted, especially when documentation does not adequately reflect the scope of the biopsy or the pathology lab reports do not align with the medical record and procedural codes. It’s essential that dermatology practices take a proactive approach to coding and documentation to avoid unwanted attention, audits, and even claw back demands from the government. Dermatology Times notes that Medicare fraud prosecutions are up 75 percent over a three year period. According to the Office of the Inspector General, as of September 2015, the Medicare Fraud Strike Force had initiated nearly 1,400 criminal actions against individuals resulting in almost 2,000 indictments and involving some $1.8 billion in fraudulent billing. 

Its so critical with changing regularity environment to hire the right medical billing service company who specialize in your specific specialty. If you have concerns about your dermatology billing practices, M-Scribe uses certified dermatology coders who understand payer-specific coding. Call us today at 888-727-4234 for a consultation on how to be proactive in the face of increased regulatory attention. 


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