Common mistakes with OWCP billing

Last Updated on: 16th March 2025, 01:28 am

COMMON MISTAKES WITH OWCP BILLING

OWCP BILLING: If you work with federal employees who have job-related injuries, you already know that the Office of Workers’ Compensation Programs (OWCP) is the agency that processes their medical claims. On the surface, it might sound simple: you treat the patient, you submit the paperwork, and you get paid. But here’s the tough reality: many healthcare practices, clinics, or billing managers keep making basic mistakes that trigger audits, payment delays, or even criminal investigations. I’m not here to hold your hand and pat you on the back. I’m here to push you to see why these mistakes happen, how they can cost you dearly, and what you can do about it, without excuses.

We are Spodek Law Group, a nationwide federal defense law firm created by Todd Spodek. Our attorneys represent clients who face federal investigations, including allegations of OWCP billing fraud or abuse. We’ve noticed repeated patterns of sloppy errors in how some providers handle claims. Those patterns might lead to serious consequences like paying back large sums of money, losing your ability to bill OWCP, or, in the worst scenarios, going to court on felony charges. Let’s be blunt: you can either fix your processes now, or risk being forced to fix them later under stressful, high-stakes conditions.

WHY OWCP BILLING ERRORS MATTER

Every claim that is submitted to OWCP goes into a database. Investigators who are looking for fraudulent activity run data analytics to catch unusual trends, repeated billing codes, or patterns of overuse. This is not guesswork; they use advanced software to spot anomalies that pop up in your claims. Mistakes that were made once or twice might slip through. But repeating the same error, or mixing up codes consistently, can raise a red flag that gets your entire practice scrutinized. If an auditor thinks you are padding bills or billing for services that were never rendered, you could face harsh federal penalties. Think about how crippling that can be: you risk financial collapse if the government demands refunds or obtains a civil judgment. Worse yet, felony charges can lead to prison time.

TOP MISTAKES THAT JEOPARDIZE YOUR PRACTICE

In our experience, these are the most common pitfalls:

• Upcoding: This is when you bill for a more expensive procedure code than what you actually performed. For example, a basic physical therapy session that was carried out may be submitted under a higher-level code. This might look like a quick way to boost revenue, but if the data analytics team notices you are consistently out of line with national averages, an audit becomes likely.
• Unbundling: This happens when a provider bills separate codes for services that should be combined under one bundled code. It might look innocent, but OWCP regulations treat it as double billing.
• Missing Documentation: The paperwork that proves what treatment you provided is crucial. If your notes, test results, or other supporting documents are incomplete, you cannot justify the codes you used. Auditors who see missing pages or vague descriptions might view you as negligent—or possibly fraudulent.
• Improper Use of Modifiers: Modifiers that were intended to explain special circumstances can be tricky. If you apply them incorrectly or forget to include them when needed, you invite denials or repayment requests.
• Lack of Patient Eligibility Checks: A patient who was not properly verified can leave you with a claim that is not reimbursable. That’s a self-inflicted wound.
• Failing to Follow OWCP Fee Schedules: The OWCP maintains specific fee schedules for services. Overcharging the government, even by accident, opens the door to an investigation.

Each mistake that was outlined above might look small on its own. But repeated often enough, these errors suggest deeper compliance issues that can snowball into major legal trouble.

THE RISK OF CIVIL AND CRIMINAL LIABILITY

Imagine you receive a letter saying you owe a large sum back to the government because of incorrect OWCP billing. That is bad enough, but it might only be the beginning. If investigators believe you “should have known” the rules yet kept submitting flawed claims, they can push for penalties under the False Claims Act, which often allows triple damages and per-claim fines. If the government thinks you acted with actual criminal intent, you can face felony charges that include possible prison time and catastrophic financial penalties. In extreme cases, you can lose your medical license or your practice. Understand the ripple effect: a criminal record that is related to healthcare fraud can end your career, devastate your personal finances, and destroy your reputation in the community.

MULTIPLE PERSPECTIVES ON COMPLIANCE

Some providers will say, “I don’t have time for all this complicated billing. Let’s just do our best and hope for the best.” Others argue that investing in a compliance program is too expensive. Let me give it to you straight: ignoring compliance is reckless. You might cut corners now, but if you get caught, the cost to fix the situation is far higher than any up-front investment in training and oversight. A robust compliance system that was implemented early can protect you from audits, or help you defend yourself if an audit happens. Meanwhile, taking a casual approach can lead to panic and desperation when the government starts digging.

HOW WE DEFEND PROVIDERS

We are Spodek Law Group. We step in when you are on the brink of crisis or already in one. Our attorneys focus on investigating every claim that the government flags. We dig into your records, we analyze your billing codes, and we look for logical explanations. If we discover that the evidence against you was illegally obtained, we move to suppress it. If the claims review process is flawed or overzealous, we challenge the government’s assumptions and highlight the weaknesses in their case. Our team can negotiate with prosecutors to reduce charges if you are facing criminal allegations. In many situations, we manage to resolve the dispute with a civil settlement that avoids the harshness of a criminal prosecution. That is the best-case scenario, but it requires a pro-active, detailed strategy.

If you have never faced an OWCP audit yet, this is your wake-up call to do things right. If you are already in the government’s crosshairs, you cannot sit still. Pick up the phone, call us, and let’s assess your situation. I will not tolerate half-baked excuses about lack of time or resources. If you value your future and your practice, you get serious about compliance and legal representation, period.

SCENARIO: REAL CONSEQUENCES FOR LAX OVERSIGHT

We once handled a case where a clinic that was offering physical therapy for federal employees consistently billed for complex treatments that were not actually given. The clinic managers tried to argue it was just a misunderstanding of coding. Investigators, however, had internal emails that suggested the clinic knew exactly what they were doing, and that they inflated claims to boost revenue. That evidence that was legally obtained turned into a powerful weapon at trial. Our firm negotiated intensely, but the government sought a felony conviction due to the scale of the fraud. Two clinic owners ended up serving prison time. This story is not about scaring you; it’s about illustrating real-world stakes. If you bend the rules, or if you simply fail to put proper guardrails in place, you are taking a massive gamble with your career and your freedom.

AVOIDING PITFALLS: PRACTICAL STEPS

1. Train Your Staff. Every member of your billing department who touches OWCP claims should get formal training. That training, which must be repeated as rules change, reduces the odds of repeated mistakes.

2. Audit Yourself Regularly. Internal audits that you design can spot coding issues before they become major. Hire an outside consultant if needed. The cost is far less than a government inquiry.

3. Document Everything. A service that was performed must be documented thoroughly. If your notes are vague, you cannot prove you provided the service you billed for. Clear documentation is your best line of defense.

4. Use Clear Policies. Written policies that explain how to code services, how to check fee schedules, and how to store records keep your staff from making random guesses under pressure.

5. Get Legal Advice Early. An attorney who knows OWCP billing can guide you in building a compliance program. You do not want to call a lawyer for the first time after an audit letter shows up.

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DISCLAIMER AND FINAL WARNING

This article, that you are reading, is for general knowledge only. It is not legal advice. Every billing situation is unique, so you should consult a licensed attorney for specific guidance. Viewing this page does not create an attorney-client relationship with Spodek Law Group. Past results do not guarantee future outcomes. The OWCP website can give you official information, but if you are already in trouble, do not rely on random internet reading to save you. The time to act is now. If you see red flags in your billing, do not bury your head in the sand.

Stop rationalizing bad habits. The government does not hesitate to punish wrongdoing, even if it started as a small mix-up. If you want to protect everything you’ve built—your practice, your reputation, your livelihood—take charge of your OWCP billing process immediately. If you do face an audit or criminal investigation, we at Spodek Law Group stand ready to fight for you. That is what we do, and we do it fiercely.