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Balance Billing - Fraud Alert
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Balance Billing

 

     Medicare is paying more attention to those who routinely violate balance billing regulations, specifically those who refuse to refund money to patients.  The Social Security Act Amendments of 1994 states that physicians, other practitioners and suppliers are liable for charges that exceed the federal limiting charges for services to which they apply. 

 

     A provider who repeatedly, knowingly and willfully exceeds the limiting charges could face heavy sanctions, including extensive fines or exclusion from the Medicare program.

 

     The Health Insurance Portability and Accountability Act of 1996 (HIPAA) amended the civil monetary provisions of Section 1128A(a) of the Social Security Act by increasing the amount of penalty for violating the balance billing limit from $2,000 to $10,000 for each item or service involved. 

 

     It also increased the assessment to which a person may be subject from not more than twice the amount, to not more than three times the amount claimed for such item or service in lieu of damages sustained by the United States or a state agency because of such a claim.  In addition the physician, other practitioner, or suppliers may still be excluded from the Medicare program for up to five years.