The Importance of Disclosures for the Out-of-Network Physician

How to protect yourself from compliance, the rise of audits & common fraud schemes [Putting it into Practice and Implementation]

There is nowhere to hide from insurance providers in this day and age when it comes to audits. They will scratch and claw until they find something to bring a potential audit against your out-of-network practice. All OON practices/physicians need to be prepared beforehand and have solid and complete steps in place to avoid preventable issues.

If you knew there was a major threat that could cost you a large sum of money or bring you to bankruptcy would you want to learn more?

Case Example

Aetna Wins $37.4M Jury Verdict Over Medical Billing Fraud

“A California jury awarded Aetna Inc. over $37.4 million in damages Wednesday after finding a network of Northern California surgical centers over billed the insurer for out-of-network procedures through a complex scheme in which referring physicians received substantial kickbacks. The victory capped a month long trial and four years of litigation against 10 defendants, including the centers, Bay Area Surgical Management LLC and the organization’s three co-founders. The surgical centers recruited patients by offering waivers of co-pays and other fees and through selling shares in the facilities to referring physicians who received handsome returns on their investments, in addition to their own fee for medical services, according to the complaint filed by Aetna Life Insurance Co.”


Plan ahead and know what information you should be getting and informing your patients on to stay compliant. In the beginning, having a plan may appear to be a hassle, but in the long run it is absolutely crucial to having a successful and efficient out-of-network practice. Just think: All your employees will have a completely comprehensible and flawless guide to follow with every individual patient and at the same time keeping you out any trouble with insurance providers.

Understanding what is needed to keep your practice compliant can help you evade costly mistakes.

Stay in control with our Free Download of our “New Patient Member Eligibility Form” below! Put our steps into practice!

Proper Methods To Verify Out-Of-Network (OON) Health Insurance Benefits


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