I work in pediatric healthcare as a benefit specialist, I bill insurance and work with patients and their finances etc. Recently a patient of ours was dismissed from therapy because she was not improving (and we needed the spot for someone who would likely improve) though that was not mentioned to anyone but me. I felt that was unfair, as there are many children at our practice that do not have the potential to improve, but we still see them. I spoke to my employers and they told me it was fraud to bill insurance for medical services that were not likely to produce results or improvements in the patient’s condition. I understand that. However, the aforementioned girl was still turned away for therapy, and multiple patients still remain treated though its the same scenario. Should I speak to my employers about this or just do what I’m told? I bill the insurance, so am I commiting fraud? And is it my business that we are treating patients unfairly?
And yes SUSIE I can read medical progress reports written by our therapists and decipher whether the patient is improving or not… and besides that, my employer straight out told me of multiple patients that continue to be treated with no hope of progress.

medical office billing