Quote:
Originally Posted by Worldseries27
Mistakes are not crimes.
|
LOL, they sure can be. Have you never heard of "Ignorantia juris non excusat"?
This Latin phrase translates to "Ignorance of the law is no excuse". It means that individuals cannot escape legal responsibility just because they were unaware of the law. Whether intentional or not, violations of laws can still lead to consequences, especially in highly regulated sectors like healthcare.
Ignorantia juris non excusat - Wikipedia
In order to run a Medicare Advantage plan, strict compliance with federal regulations is required, especially in areas like coding and billing. The government mandates that professionals employed in these roles are properly trained and certified by recognized, independent agencies. Certifications like the Certified Professional Coder (CPC), awarded by the American Academy of Professional Coders (AAPC), or the Certified Coding Specialist (CCS) offered by the American Health Information Management Association (AHIMA), are crucial for ensuring compliance with Medicare's complex rules.
Individuals working in healthcare billing and compliance must also hold certifications like Certified in Healthcare Compliance (CHC) from the Compliance Certification Board. These certifications ensure accuracy and legitimacy in billing processes, specifically to mitigate the risk of errors that could lead to legal or financial penalties.
This is not just a matter of following protocol, it's a legal requirement. The Medicare program is under constant oversight by agencies like CMS (Centers for Medicare & Medicaid Services), and any failure to comply with the established rules, even if accidental, can result in significant repercussions. Mistakes in coding, billing, or compliance, even if unintentional, can lead to fraud charges, fines, and even criminal liability.
So mistakes can be criminal if they lead to fraudulent claims, improper reimbursements, or violations of federal standards.