The administrative team is responsible for accurate claims submissions. Team members who falsely submit claims because their employers requested them to do so, cannot escape liability by pleading ignorance. Some examples of insurance falsification include:
Submitting claims for treatment not provided, including coding a procedure differently to receive a higher fee. For example, submitting a simple extraction coded as a surgical extraction.
Changing fees on a claim form to receive a higher payment.
Disregarding a deductible or co-payment, accepting only the insurance payment and writing off the difference.