In the recent months health care providers have been scrambling to get the vaccine out to Americans, and some are now under investigation for mishandling the rollout of the most recent vaccine. According to the CDC, any Covid-19 vaccine must be provided and administered at no out-of-pocket cost to the recipient. If a vaccine was the sole purpose of the medical visit, no additional “office fees” may be charged either. While vaccine providers are allowed to seek reimbursement from private and public insurance entities, those costs cannot be passed on to patients.
Insurance entities, including Medicare, are charged fees in the hundreds. The fees can be several times more than what the government has paid Pfizer, Moderna and Johnson & Johnson for Covid-19 vaccines, which is between $10-$40. Even when it comes to charging insurance companies, vaccine providers can be inconsistent. Some private insurance companies have been charged $40-50 per dose for an administration fee, which is legal as long as the insurance companies don’t pass the cost on to consumers.
If you own or operate your own health care clinic you likely know that basic medical coding errors have the potential to cost your medical practice hundreds of thousands or more in lost revenue. When the government and insurance companies deny claims with medical billing and coding errors under the CPT code, your health care group loses reimbursement revenue until you can correct and resubmit a proper claim. The most common medical billing and coding errors lead to high denial rates and may compromise patient care. The more serious consequences of upcoding and acts of medical abuse and fraud could have your group facing federal penalties and expensive fines.
If you are a physician, medical assistant, or nurse practitioner and you believe your clinic is being investigated under the False Claims Act or another civil/criminal statute, it is imperative that you contact our legal defense team to see what we can do for you. Call our office at 559-233-5333.