February 11, 2016


Hello Jennifer,

I really enjoy reading your newsletter. It is very informative.

I was wondering if there is anyway to monitor for fraudulent billing? What if someone used a physicians's NPI and started submitting fraudulent claims without the physician ever being aware? Does this ever happen? Is there anyway to protect against this kind of identity theft?

Warm Regards,

Dr. E

Excellent question.  I do see this come up.  Most frequently I see this after someone leaves a position and they maybe suspect and then confirm or receive notice from a payor that claims are still going out under their name.  I am not familiar with a "data lock" or other fraud protection product protecting from misuse (possible product idea for those in industry reading!), but I do have a tip.  The same way you wouldn't want your credit card numbers misused or on the open market, please take care to protect your NPI or use of name on billing information. Make sure to keep a current list of the payors you participate with and locations/offices credentialed to you. Upon leaving a position or adding a new location be sure to personally confirm the payors you are credentialed for are notified of your change in circumstance. If you should become aware your identifier is being used in an unauthorized capacity, available steps include immediately telling the payor you are not affiliated with that practice or location and filing a police report. You may also want to lodge a complaint to the Department of Finance (formerly the Department of Insurance).  And, of course, it doesn't hurt to keep your lawyer in the loop. 

Hope this helps!

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