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common mistakes with owcp billing lawyers

July 1, 2020

The use of worker’s compensation as a way of recouping medical expenses following an accident at work can be a tough one. Choosing to work through the worker’s compensation program is one that should be done with extreme caution because the issues that can be faced are many and extremely difficult to cope with. Perhaps the best option is to make sure every billing requirement is completed by a medical billing specialist who has experience OWCP to ensure any problems are avoided before the authorities become involved. One of the unique aspects of working through the worker’s compensation program is that mistakes can be prosecuted even when they are unintentional.

The False Claims Act

The funds being made available through the Worker’s COmpensation program are protected under the rules of the False Claims Act. What makes OWCP such a unique program is the fact it leaves no room for human or computer error in the decisions made regarding the use of certain codes for medical treatments completed and supplies obtained.

When a biller is using Medicaid and Medicare billing procedures they will often have their claims kicked back to them if the codes they input are seen to be incorrect. In contrast, the False Claims Act makes it a felony for the incorrect information to be used when claiming the Worker’s Compensation. In the eyes of the law in the U.S., the biller chosen to complete the paperwork for any OCWP claim should understand the codes enough to avoid mistakes.

Using Treatments that are not Covered

For billing specialists, one of the major issues being faced is how to ensure any treatment that is used is covered by the program. One of the most commonly seen mistakes is a biller believing the treatments and procedures covered by other federal health insurance programs are covered by WOrker’s Compensation. This is untrue and can lead to problems with payments and federal investigations when compensation is called for by an organization.

A common mistake for those who are looking for different ways of treating a specific medical condition is that the providers who are used for Medicare and Medicaid programs will also be for Worker’s Compensation. Among those who are permitted within the Medicare and Medicaid programs are chiropractors and Acupuncturists who have moved into the mainstream of western medicine. Despite their new position as mainstream medical professionals, the majority of Worker’s COmpensation claims are not permitted in these areas of treatment.

Compliance is Needed

In most healthcare environments, the focus of the elimination of fraud falls on investigating authorities as long as those providing care maintain their compliance with the rules and regulations in place. OWCP switches the issue of compliance onto the healthcare organization handling the claim to make sure they are actively avoiding any criminal activity.

The use of HIPPA laws is mandated throughout the healthcare industry in the U.S. and this is often the singular option for most insurance providers and medical facilities. Those that accept Worker’s Compensation will usually find themselves having to actively seek out and halt any signs of criminal activity to remain within the rules of the government-controlled program.

Referral Problems

The OWCP program has long been identified as one that is hard to work with as the issue of referrals does often rear its head and call for kickbacks to be considered. When choosing a pharmacy or another medical provider to be chosen the Stark Law means no financial gain can be obtained by a physician making the referral. If a prescription is sent to a pharmacy linked to a clinic and the physician is a director of the establishment they could fall foul of the Stark Law. This only adds too much of the confusion that is often found in the use of OXCP insurance and the common problems with billing and financial gain.

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