You may work in the billing department of a hospital or another medical facility, and throughout the course of your duties, you may have suspected that doctors were overbilling patients and insurance companies. At first, you may have thought that the doctors were making valid entries for bills, but upon closer inspection, you started to suspect wrongdoing.

What does overbilling look like?

Overbilling patients and insurance companies is a fraudulent act. You certainly do not want the defrauding of anyone to occur, especially sick patients in need of help. Of course, you do not want to make wrongful accusations either. However, if you have noticed any of the following issues with medical bills, you may have reason to blow the whistle:

• A doctor or multiple doctors consistently provide unnecessary services to patients in order to charge for those services.
• Medical staff members may charge for services that they did not perform.
• A medical professional bills a patient for each service individually when the services could have been bundled, thus saving the patient money.
• Staff members receive referral kickbacks from other providers.
• Doctors bill patients for more expensive versions of a service.

Of course, health care fraud can come in other forms too. As a result, it is understandable if you feel unsure about your suspicions. You may also worry about coming forward with your suspicions out of fear of retaliation. Fortunately, you could seek protection under the federal False Claims Act.

What can the act do?

If you feel it is necessary to blow the whistle on the company for which you work, the FCA could allow you to file a lawsuit on behalf of the United States government and obtain a reward, typically a percentage of proceeds collected from the government, if the company is prosecuted.

If you believe that you have reason to take such action, you may want to discuss the matter with an experienced Kentucky attorney. Your legal counsel can help you assess your suspicions, determine whether you have reason to move forward with a claim and explain how the FCA could protect you.

If you are considering entering an independent medical practice, the contract is arguably even more crucial than if you were to take a job at a hospital or clinic. In these settings, procedures and human resources departments are more established and, therefore, standardized. You must discover whether the medical practice you intend to join has everything in order before you commit.

8 things to watch for

• What is the nature of your relationship with the practice? Are you an employee or an independent contractor?
• If there is an affiliation with a hospital, find out if you will be expected to practice in that hospital. Some hospitals have better reputations than others. You may or may not be comfortable with a connection to that institution.
• Apart from clinic time, what other duties will you be responsible for? Will you need to participate in business development? Attend meetings at an affiliated hospital or within the practice? If so, how much time will the practice expect you to dedicate to these activities?
• How will they compensate you? Is it a base salary plus bonus, a fee-for-service arrangement or item-by-item reimbursement with a value-based payment component?
• What quality parameters does this facility uphold? Are you comfortable with the facility’s standards?
• What disclosure and obligations does the contract include? Are you amenable to all that’s listed? Examples might consist of staff privileges, on-call expectations or an agreement to bill only through the practice.
• What benefits does the contract include? Will the practice cover continuing education? What about insurance and retirement?
• What are the conditions for termination? How long will the contract be in effect? How can you terminate the contract? Can the practice terminate only with cause or at will? Is there a non-compete clause?

Contracts are complex. Make sure you get the facts before agreeing to take the job. These eight points are a place to start when evaluating whether a job offer at an independent medical practice is right for you.