United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2001-06-27 monographic deposited born digital GA 1.13:GAO-01-899T https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-899T P0b002ee180384913 f:d01899t DGPO 2010-08-12 2011-03-28 GAOREPORTS-GAO-01-899T machine generated eng fdlp REPORT GAOREPORTS-GAO-01-899T GAO-01-899T Health care programs Overpayments Health insurance Consultants Billing procedures Fraud Program abuses Medicaid Program Medicare Program Testimony A01266 This testimony discusses the results of GAO's investigation concerning health care billing consultants who conduct seminars or workshops that offer advice to health care providers on how to enhance revenue and avoid audits or investigations. Consultants at two workshops that GAO attended provided in-depth discussions of regulations that pertain to billing for evaluation and management health care services and compliance with health care laws and regulations. Certain advice provided during those discussions is inconsistent with federal law and guidance provided by the Department of Health and Human Services' Office of Inspector General. Such advice could result in violations of both civil and criminal statutes. Specifically, certain consultants advocated not reporting or refunding overpayments received from insurance carriers after they were discovered. The consultants also encouraged the performance of tests and procedures that are not medically necessary to generate documentation in support of bills for evaluation and management services at a higher level of complexity than actually confronted during patients' office visits. Also, GAO is similarly concerned with statements about billing practices made by a private consultant it also contacted. This testimony summarizes the June report, GAO-01-818. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-01-899T/html/GAOREPORTS-GAO-01-899T.htm GAO-01-899T https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-899T Testimony GAO-01-899T; Health Care: Consultants' Billing Advice May Lead to Improperly Paid Insurance Claims; Health care programs Overpayments Health insurance Consultants Billing procedures Fraud Program abuses Medicaid Program Medicare Program