Just Because There’s No Sheriff Doesn’t Mean You Should Break the Law

Boy, such pushback.


I’ve recently written about how a recent Federal Court ruling pretty much opens the door to risk-coding however you want.


I never said you should lie and make stuff up.


True, for now there is no longer any mechanism to enforce accurate risk-coding, and no real penalty for crossing the line. Nor is there likely to be any for some time.  And anything that is implemented will be very unlikely to be applied retroactively.


Yes, Medicare Advantage Organizations will continue to perform internal validation audits, but the amount of overpayments they return to the Federal government is completely at their discretion—-I’m guessing it’ll be less than the full amount.


For all its brutal truth, my analysis is one that you won’t find anywhere else.  When the burglar finds the bank vault door unlocked, he’s not going to tell anyone.


You are not a burglar.  And despite all the feedback I’ve been receiving, I never suggested you should act like one.


Code accurately and thoroughly.  Learn the codes that only you, as a prime, can identify.


But don’t make stuff up just to generate a buck because you know nobody is watching.


It’s wrong. It’s not what you’re about.


And it’s also a very bad habit to get into.


The Medicare trust fund is not a bottomless pit of cash.


There will come a day of reckoning, when only those who risk-code accurately will avoid sanction.


If for no other reason, learn to risk-code appropriately in anticipation of that day.


Leave the fraud and the bad karma to others.


You do the right thing.