STATE FALSE CLAIMS AUDITOR'S MISSION

State False Claims Auditors Organization(SFCA) mission is to protect the integrity of Medical & Dental professionals as well as the health and welfare of beneficiaries by running awareness programs. We don't call doctors or patients for any services.

False Claims Indicators

 

Office of Inspector General(OIG) always keep tracking the medical and dental professionals claims carefully to ensure that patient, Insurance and doctor getting proper rewards against their efforts.

Office of Inspector General’s Compliance Program Guidance for Individual and Small Group Physician Practices;

a. Coding and Billing. A major part of any physician practice’s compliance program is the identification of risk areas associated with coding and billing.

 

1) Billing for items or services not rendered or not provided as claimed.

2) Submitting claims for equipment, medical supplies, and services that are not reasonable and necessary.

3) Double billing resulting in a duplicate payment.

4) Billing for non-covered services as if covered.

5) Knowing the misuse of provider identification numbers, which results in improper billing.

6) Unbundling (billing for each component of the service instead of billing or using an all-inclusive code).

7) Failure to properly use coding modifiers.

8) Clustering.

9) Upcoding the level of service provided.

10) The medical record is complete and legible.

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Patient's

Rights & Priorities.

 

A patient hold full right to report their problems, if they suffered any treatment-related issues due to;

  • Poor Clinic performance and Management.

  • If they are being overcharged.

  • Performed unnecessary treatment.

  • Misleading with wrong interpretation of symptoms and diseases.

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START CARING.

 

Health care fraud is not a minor crime, and a conviction of health care fraud could lead to jail time and the loss of a professional license to practice. If you are accused of health care fraud, you may suffer the following penalties;


1) Lengthy jail or prison time.


2) Fine of up to $250,000


3) Restitution for any amount that the defendant profited


4) Probation


5) Loss of professional license.

Since its 2014 establishment, SFCAO has been at the forefront of the US dentist and medical professional efforts to fight waste, fraud, and abuse in Medicare, Medicaid, and more than 100 other commercial programs.

SFCO is the largest medical professionals and tx plan auditors office, with approximately 120 dedicated to combating fraud, waste and abuse and to improving the efficiency of medical and dental practices. A majority of SFCO resources goes toward the oversight of Medicare and Medicaid — programs that protect the patient's, medical and dental professionals compliances and rights which affect this country's most vulnerable citizens.

SHIELD YOUR PRACTICE.

 

We carry out our mission using a multidisciplinary, collaborative approach, with six sigma specific protocol which plays a vital role in administration oversight.

A nationwide network of audits, investigations, and evaluations results in timely information as well as cost-saving or policy recommendations for decision-makers and the public. That network also assists in the development of cases for criminal, civil and administrative enforcement.

SFCO develops resources to assist the health care industry in its efforts to comply with the Nation's fraud and abuse laws and to educate the public and medical professionals about fraudulent schemes so they can protect themselves and report suspicious activities to OIG.

SFCO is individual non-government body working independently to help patients and medical professionals.

We are dedicated to;

1) Regular Treatment Plan audits.

2) CCI, LCD, NCD, HCPCS, PCS, DRG, and CRA validation according to the HHS, CMS, and CDC guidelines.

3) Patient awareness program on HHS guidelines.

4) Helping OIG through social awareness programs.

Office of Inspector General (OIG) New Updates

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OIG Most Wanted Fugitives

This webpage contains information about OIG's most wanted health care fugitives. In all, OIG seeking more than 170 fugitives on charges related to health care fraud and abuse. Navigate to other sections of our fugitives site to learn more: 

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Patients Alert & Awareness

We individual auditor group helping healthcare professionals through awareness programs. There are Genetic Testing Scam, Nationwide Brace Scam, HHS OIG Hotline Telephone Number Used in Scam, New Fraud Scheme Targeting Families of Unaccompanied Children, Consumer Fraud in the Health Insurance Marketplace, Fraud Alert for People with Diabetes, Grant Fraud Alert, Medical ID Theft/Fraud Information and many more.

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Compliance & Guidelines

OIG has developed a series of voluntary compliance program guidance documents directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal controls to monitor adherence to applicable statutes, regulations, and program requirements. We individual auditors help to understand why guidelines are important to follow without any fee.