Submitted By Anonymous

A client was seeing me through workman’s compensation. She was going on vacation and did not want her case manager to know she was skipping two visits. She wanted me to lie and bill them for two visits that she would make up for later. I refused, and she was incensed. Still refused.

If you were confronted with the same situation again, how might you handle things differently?

Response from Anonymous

I would not have handled things differently.

Response from Institute for Integrative Healthcare Studies

Refusing a client’s request to do anything illegal should be an easy decision, especially when it comes to reimbursement from a third party such as an insurance company, government agency or employer. Agreeing to receive payment for a service not performed is a serious crime and the healthcare professional could face serious consequences including fines, repayment of reimbursement and a loss of license or accreditation.

Filing a false or doctored insurance claim is considered a Federal offense under the Federal False Claims Act and is a violation of HIPAA (Health Insurance Portability and Accountability Act). Depending on the local jurisdiction and the severity of the fraud, punishment can range from community service and parole, a fine between $5,000 and $10,000, and/or jail from 10-20 years.

If a client asks you to submit a false or altered claim, always remember to ask yourself, “Is it worth losing my license, jail time and a hefty fine?” The answer should always be no!