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May 29, 2003 - Essay
Fraudulent Medical Billing Opportunity Schemes Infiltrate Market


There has been a troublesome trend in the medical billing and practice management services marketplace over the past few years. Many unscrupulous companies and individuals target people within the general population who usually have no experience in billing or practice management, and attempt to sell a business opportunity processing claims for physicians and performing other associated services. The charge to the person for this "opportunity" ranges from a few hundred dollars, all the way into the tens of thousands of dollars.

These types of fraudulent opportunities to start billing services have many victims. They include, but are not limited to the purchasers of the opportunities and physicians who may unsuspectingly hire companies who have bought into these opportunities and who have little or no experience in the field of medical practice reimbursement. Physicians are at great risk of partnering with incompetent companies who may actually negatively impact practice reimbursement rather than maximizing it.

Reputable and well-established billing services and practice management companies are also indirectly affected as the slew of new billing companies generated by these bogus business op's muddy the waters of the marketplace. Finding a reputable company becomes harder than it sounds.

Many companies selling medical billing opportunities are often software vendors, who have had little success in marketing their wares to the physician or established billing service marketplaces, and therefore turn to the general public to make sales. Others are billing services which have had little or no success obtaining and maintaining clients themselves, and therefore turn to perpetuating a vicious cycle in order to realize profitability.

A typical business opportunity package will include basic billing software, promotional materials, such as form letters to be sent to medical practices advertising the new billing service, as well as some rudimentary medical billing training. Some are even so bold as to state that they will find willing physicians for the new billing service and will refer them to the buyer.

Claims of huge profits and the ability to work from home make it easy for unethical operators to prey on stay-at-home parents, disabled persons and the retired. Furthermore, you need look no further than your Sunday paper, the Internet, or entrepreneurial and business magazines, to find advertisements boasting wonderful opportunities in the medical billing field. Don't read these things? That's OK, some companies have no problem hiring telemarketers to bring their message to unsuspecting victims.

A glimmer of hope is on the horizon. The Federal Trade Commission (FTC) has started investigating some of these schemes and has successfully prosecuted others. In one recent example, the FTC prevailed in a case against Medicor, LLC, which sold at-home medical billing opportunities to over 40,000 people. Medicor was ordered to pay over $16.5 Million in damages to its victims (details). It can only be hoped that the FTC continues such investigations and that fraudulent operators get the message.

So what can physicians and medical groups do to make sure they do not hire a lemon? Try asking some hard questions of the prospective service company.

For starters, ask for references - other physicians and practices you can call and talk to about their experiences with the company you are considering.


  • From there, look at the infrastructure. Are they established in a professional setting, or do they work from home?
  • Do they employ experienced people, or is this a new endeavor?
  • Do they understand and maintain HIPAA and OIG compliance?
  • Check on their Information Technology infrastructure. What systems do they use?
  • Are the companies providing them with software which is reputable and financially stable?
  • Are their systems suited to a practice of your size and does it meet your requirements?
  • Is the perspective company itself financially stable?
  • Is it currently profitable?
  • Is it riddled with external debt?
  • You will want to ask specific questions about reimbursement processes, transfer of information, and perhaps even coding.

If they cannot answer these types of questions or have difficulty answering them, that should raise some red flags to be taken into consideration.

One thing is certain, medical billing companies directly affect practice reimbursement, practice stability, and ultimately the salary of the physician. Good companies have the unique ability to maximize reimbursement while alleviating many troublesome tasks. Ultimately, there is no substitute for experience, stability and reputation.

For more information on the FTC's case against Medicor, click here

If you suspect a fraudulent opportunity or if you feel you have been victimized, visit the Federal Trade Commission's website at www.ftc.gov