Massage Therapists – Prevent Insurance Fraud

In my previous article “Massage Therapy and Insurance Fraud”, I discussed at length the situations in which a massage therapist may find him or herself in a case of fraudulent billing.

It’s important to remember that direct billing of an insurance company is a privilege that our profession has worked very hard to achieve. Fraudulent billing not only detracts from the integrity of the massage therapy profession, it also calls into question your integrity as a therapist and person. Your insurance billing identification should be treated like your passport, driver’s license and social security/insurance number, and protected at all times.

Assuming that you yourself aren’t committing insurance fraud, I have some suggestions which may help you avoid this slippery legal and professional slope, and protect your license while working in a business.

1) If you are a contractor, you have the right to establish your cancellation/no-show policy and conduct your business as you see fit (within reason). Ask the clinic and co-worker what their policies are concerning missed appointments and non-compliance. If their policies seem reasonable, then it is to your advantage to be consistent with the business in which you work.

If you are an employee, unfortunately you are pretty much stuck with following the guidelines of your employer.

2) If front-office staff is responsible for booking the appointments on your behalf, ask them if clients are advised when booking appointments of the no-show and cancellation policies. No? This makes it a little more awkward, but I would suggest – if the front office staff will not, or forgets, to mention the policy – creating a waiver which is part of the health history intake. This waiver should state your policies, and you should not only ensure it has been read and signed, you may also want to verbalize this to your clients before treatment.

3) Do you do your own billing? If not, whether or not you have signed a waiver permitting front-office staff to bill for you, you need to keep a close eye on your account.

If the business in which you work has asked you to sign a waiver permitting them to bill on your behalf, you may want to provide your own addendum which states that you do not give permission to bill on your behalf for i) treatments which didn’t occur or not provided by you ii) last minute cancellations or no-shows, iii) treatments other than the accepted massage therapy treatment modalities. (consult your professional association or college to find out which modalities are grouped under massage therapy in your jurisdiction). You may also want to include that the liability lies with the management for any of the above situations. Don’t forget to get the clinic or spa manager to sign the addendum to the waiver.

(realistically, I doubt that many clinic or spa managers will do this, but it’s worth a try. Remember that your billing number is your responsibility, and if no such agreement exists, you will likely take the heat if the insurance fraud allegation comes up)

4) Every week or so, compare your insurance account with the list of treatments you have provided. If you notice that there are charges for treatments that never occurred or you didn’t provide, I recommend that you bring it to the attention of the clinic/business owner, and front office staff in writing. Give everyone the benefit of the doubt, and assume that this was an error. Advise the clinic that you will have to notify the insurance company to reimburse them – note, however, that if you haven’t received the money, you expect the clinic/business to reimburse the insurance. A refusal on their part to do this is not a good sign of their honesty. If this is the case, send them another letter and …

5) Mail yourself a copy for good measure (and don’t open it, put it in a safe place. The postmark can be used to verify dates should the law ever become involved). Use registered mail to send the clinic the letter and print the receipt of when the clinic received it.

6) In the case of 4 & 5, you may need to find another place to practice, so get moving on that – after all, all signs would indicate that perhaps that the business where you work is involved in fraud, or is, at the very least, unethical. Do you really want your name and professional reputation associated with that? I didn’t think so.

Keeping these above points in mind will help you maintain your professional integrity and raise the transparency of the profession. Only by doing so will the massage therapy profession position itself as a health care industry deserving of insurance billing privileges.

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