Health care providers have an important responsibility when it comes to delivering proper care and treatment for their patients. In doing so, they are also responsible for ensuring that complete and accurate information is submitted to the insurance companies for reimbursement. Otherwise, they risk overcharging federal health care programs (i.e., Medicare and Medicaid) or private insurance carriers, which could ultimately lead to government enforcement actions, penalties, or other civil actions. Luckily, providers can utilize resources like third-party billing companies to help navigate the complexities of the health care reimbursement process. While this is the direction many providers are heading, they should understand the inherent risks and compliance requirements of these arrangements, especially in the heavily regulated health care industry.

Third-Party Billers in the Health Care Business

While conducting a recent forensic investigation, we researched statistics related to the use of third-party billing companies in the health care industry. We learned that health care providers are increasingly relying on third-party billing companies. According to a study by Precedence Research, the U.S. medical billing outsourcing market is expected to increase from $5.22 billion in 2023 to an estimated $5.89 billion in 2024 (a 12.8% increase) and reach approximately $18.74 billion by 2034