Spotting Irregularities in Treatment and Billing Records

Medical records have never been more prevalent in civil litigation. Each healthcare facility, whether a hospital, urgent care, or other specialty clinic, has their own unique record keeping, note taking, and billing systems. As with all businesses, not all medical treatment providers abide by the same standards in their billing and record keeping practices. Due to the variety of medical treatment providers, it has never been more important to know how to identify potential irregularities in treatment and billing records which could indicate improper record keeping or excessive billing practices.

Some items that may indicate potential irregularities, and the need for additional investigation, include: failure to conduct orthopedic testing consistent with patient complaints, treatment beginning several months after the injury event at issue, lack of signature time stamps indicating when notes were completed, billing codes that do not match the actual exams performed, extensive examinations taken after symptoms are stated to have resolved, and billing entries for physicians that are not indicated on the treatment visit note.

If your review of medical records reveals any of these factors, it may be worth seeking an expert peer review of the relevant treatment records to determine if the medical care provided and subsequent costs were reasonably justified. Such peer reviews may reveal accidental entries or outright improper billing and treatment practices which can be beneficial in facilitating a resolution of the case.