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Alter4578
Mar. 17, 2012, 09:45 PM
I saw a new doctor who was recommended to me by a family member, when I was filling out all the initial paper work in the waiting room, I was given a blank CMS-1500 insurance claim form, and asked only to sign it and fill in the date.

At the time I signed it, I was thinking that signing a blank form probably wasn't such a good idea. But I don't have a lot of experience with health insurance, the doctor has a good reputation, so I figured that they would fill in all the information about my visit later, then submit the completed form to the insurance company, and this must just be the way some doctors handle the claims process.

Anyway, a few weeks later when I was feeling better, I thought about having signed the form, and looked it up on google. Then I saw that there are many warnings listed by federal (the FBI) and state agencies, and insurance companies, that all warn against ever signing a blank health insurance form to prevent health insurance fraud.

I sort of panicked, and I called my insurance company to ask if I had done anything to worry about by signing the form. The insurance company representative was very nice, told me that I did the right thing by calling them about this, and then they called the doctors office to find out why I was asked to sign the form.

After speaking with the doctors office, the representative told me that the doctor uses the blank signed form to keep a 'signature on file' to use for filing insurance claims, the representative told me that she didn't think there was anything to worry about, but also told me that if that form was used for fraud, that "it would be on me".

I thought about what I was told, and then I started to think about what might happen if someone ever stole the doctors records and got there hands on all of those blank signed forms, couldn't they then use all of those forms to commit fraud?

I called the doctors office, verified with them that they had just spoken with the insurance company, and I asked them if would they would fill in 'item 32' (Service Facility Location) on the form I had signed so the form would be "linked" to the doctors office. They agreed to do this for me, but told me they have been using this system for years without any issues.

I later stopped by the doctors office to pick up a photocopy of the form for my records, and they had filled in the service facility location with the doctors information.

....

Questions I'm hoping someone here might be able to help me with:

I still have this looming question in my mind that asks, if there are so many warnings that say to never sign blank health insurance forms, then why is this doctor using signed blank insurance forms as 'signature on file' documents, when he could just as easily be using one of those short little one paragraph "I authorize Dr. whoever to make claims on by behalf" forms like the other doctors I have visited had me sign?

Does anyone know if a signed and dated. but otherwise blank, CMS-1500 form can even be legitimately used as a signature on file document?

Wouldn't the CMS-1500 form have to actual say on it that it's going to be used for signature on file purposes, in order for that signature to give authorization to be used for that purpose?

Also, by having the doctors office fill in the service facility location with their information, have I done enough to protect myself against anything "being on me" as my health insurance company representative had explained it?

Should I still be worried about this?

Is this a common practice in to use blank claim forms like this, and I just don't know about it?

Thanks for any help anyone might provide in helping me understand any or all of these questions. Even you don't know the answers, your thoughts about what you would have done it the same situation would be helpful to hear.

Note that I even sent an email to the state of NJ with these questions, and they basically told me that it depends on whether such use is acceptable under my insurance company's guidelines, and what the doctor actually does with the form.

But what I'm asking is if I should ever sign a blank form again in the future if another doctor asks me to, and should I leave this form that I did sign as is, or should I contact the doctor and revoke it?

Also, if signing blank forms turns out to be something that I should never do again, how should I deal with it when a doctor asks me to sign one. Should I refuse to sign it and walk out of the office? Is there something I might write on the form to void it so it can never be used for fraud?

I wish I had more experience with the health care system so I'd know about these things.

Alter4578
Mar. 18, 2012, 02:29 AM
Bumping up with hopes that someone might have some experience with the health insurance system and the use of claim forms.

2DogsFarm
Mar. 18, 2012, 06:35 AM
You can relax, I work for a pharmacy/home infusion business and the 1500 you signed is a billing form the doctor's office will submit with the coded information re: your visit so they get paid.

It is common to submit these forms with the box you signed/dated marked "signature on file", and in that case the office just has you sign a different form - called an AOB (Assignment of Benefits) - stating you agree to have the doctor submit his claim directly to the insurance company instead of billing you and you paying him then you have to file the claim with your insurance to get reimbursed for what they cover aside from your co-pay, deductible, etc.
The AOB will also include a paragraph stating you understand you are responsible for the charges in full (if insurance denies) and for anything the insurance does not cover.

Signing the AOB or 1500 just makes it easier for the doctor to get paid and less paperwork for you.
You will get a copy of the Explanation of Benefits from your insurance that explains what they were charged, what was covered/paid and what you may owe when they settle the claim with the doctor.

Welcome to the world of Federally mandated paperwork :mad:

Alter4578
Mar. 18, 2012, 07:15 AM
You can relax, I work for a pharmacy/home infusion business and the 1500 you signed is a billing form the doctor's office will submit with the coded information re: your visit so they get paid.

It is common to submit these forms with the box you signed/dated marked "signature on file", and in that case the office just has you sign a different form - called an AOB (Assignment of Benefits) - stating you agree to have the doctor submit his claim directly to the insurance company instead of billing you and you paying him then you have to file the claim with your insurance to get reimbursed for what they cover aside from your co-pay, deductible, etc.
The AOB will also include a paragraph stating you understand you are responsible for the charges in full (if insurance denies) and for anything the insurance does not cover.

Signing the AOB or 1500 just makes it easier for the doctor to get paid and less paperwork for you.
You will get a copy of the Explanation of Benefits from your insurance that explains what they were charged, what was covered/paid and what you may owe when they settle the claim with the doctor.

Welcome to the world of Federally mandated paperwork :mad:

Thank you for the explanation, I bolded the part of your reply that I'm still confused about.

The doctor did not send the 1500 form that I signed to the insurance company, he instead put that signed 1500 form in his office files and said it was for keeping my signature on file. My insurance company did pay the claim, but my insurance company said the doctor filed it on a different 1500 form than the one I signed, one that said "signature on file" on it.

I thought he was going to use the form I signed to file the claim like you said, but he didn't, that's why I'm worried about this.

I remember what the AOB (Assignment of Benefits) form looks like because I signed one of those for a different doctor. I don't think I signed one of those for this doctor, unless it was a part of the symptom/medical information form that I filled out?

Can a signed but blank 1500 form also be used as an AOB (Assignment of Benefits) form? Because that's what this doctor is using it for.

sketcher
Mar. 18, 2012, 08:35 AM
I think you are worrying too much. It sounds like the Dr has your signature on file so that you do not have to sign a new form every visit and if they have been doing it for years and the insurance companies ore ok with them writing "signature on file" then it seems kosher. If you are worried then look at your explanation of benefits that you get after a visit to see what was charged.

LauraKY
Mar. 18, 2012, 10:26 AM
Sounds like the doctor needs to use an assignment of benefits form and step into the 21st century. Maybe she/he needs a new office manager.

Coanteen
Mar. 18, 2012, 10:40 AM
I'm kind of confused as to why they won't do the same thing as when you sign a blank check just for a signature: write a big "VOID" across the rest of it. That way no worries about the signed form being used for any nefarious purposes.

furlong47
Mar. 18, 2012, 11:06 AM
My old dentist's office did that, or similar. I don't know if it was that exact form, but I signed the form from the insurance company and they kept it on file. Every other doctor or dentist I've ever visited has only wanted a photocopy of my insurance card.

pj
Mar. 18, 2012, 11:21 AM
I saw a new doctor who was recommended to me by a family member, when I was filling out all the initial paper work in the waiting room, I was given a blank CMS-1500 insurance claim form, and asked only to sign it and fill in the date.

At the time I signed it, I was thinking that signing a blank form probably wasn't such a good idea. But I don't have a lot of experience with health insurance, the doctor has a good reputation, so I figured that they would fill in all the information about my visit later, then submit the completed form to the insurance company, and this must just be the way some doctors handle the claims process.

Anyway, a few weeks later when I was feeling better, I thought about having signed the form, and looked it up on google. Then I saw that there are many warnings listed by federal (the FBI) and state agencies, and insurance companies, that all warn against ever signing a blank health insurance form to prevent health insurance fraud.

I sort of panicked, and I called my insurance company to ask if I had done anything to worry about by signing the form. The insurance company representative was very nice, told me that I did the right thing by calling them about this, and then they called the doctors office to find out why I was asked to sign the form.

After speaking with the doctors office, the representative told me that the doctor uses the blank signed form to keep a 'signature on file' to use for filing insurance claims, the representative told me that she didn't think there was anything to worry about, but also told me that if that form was used for fraud, that "it would be on me".

I thought about what I was told, and then I started to think about what might happen if someone ever stole the doctors records and got there hands on all of those blank signed forms, couldn't they then use all of those forms to commit fraud?

I called the doctors office, verified with them that they had just spoken with the insurance company, and I asked them if would they would fill in 'item 32' (Service Facility Location) on the form I had signed so the form would be "linked" to the doctors office. They agreed to do this for me, but told me they have been using this system for years without any issues.

I later stopped by the doctors office to pick up a photocopy of the form for my records, and they had filled in the service facility location with the doctors information.

....

Questions I'm hoping someone here might be able to help me with:

I still have this looming question in my mind that asks, if there are so many warnings that say to never sign blank health insurance forms, then why is this doctor using signed blank insurance forms as 'signature on file' documents, when he could just as easily be using one of those short little one paragraph "I authorize Dr. whoever to make claims on by behalf" forms like the other doctors I have visited had me sign?

Does anyone know if a signed and dated. but otherwise blank, CMS-1500 form can even be legitimately used as a signature on file document?

Wouldn't the CMS-1500 form have to actual say on it that it's going to be used for signature on file purposes, in order for that signature to give authorization to be used for that purpose?

Also, by having the doctors office fill in the service facility location with their information, have I done enough to protect myself against anything "being on me" as my health insurance company representative had explained it?

Should I still be worried about this?

Is this a common practice in to use blank claim forms like this, and I just don't know about it?

Thanks for any help anyone might provide in helping me understand any or all of these questions. Even you don't know the answers, your thoughts about what you would have done it the same situation would be helpful to hear.

Note that I even sent an email to the state of NJ with these questions, and they basically told me that it depends on whether such use is acceptable under my insurance company's guidelines, and what the doctor actually does with the form.

But what I'm asking is if I should ever sign a blank form again in the future if another doctor asks me to, and should I leave this form that I did sign as is, or should I contact the doctor and revoke it?

Also, if signing blank forms turns out to be something that I should never do again, how should I deal with it when a doctor asks me to sign one. Should I refuse to sign it and walk out of the office? Is there something I might write on the form to void it so it can never be used for fraud?

I wish I had more experience with the health care system so I'd know about these things.
I've only once had the experience of being asked to sign one. A new dentist and I stupidly signed it. Later found out he had claimed doing two thousand dollars worth of work on me which hadn't been done. Insurance paid before I found out. I was later summoned to a hearing on this dentist. Seems I wasn't the only one he'd pulled this on. Don't know if the insurance companys got their money back but he was suspended from practice for three years.

Long Spot
Mar. 18, 2012, 11:31 AM
Hubby works in the ER and it rang his bells as a possible problem, yeah.

The whole point of your signing a 1500 is that you are testifying to validity of it. If you don't know what they have claimed, then you shouldn't be signing it. And you haven't, but they are making it look like you did.

Perhaps it is totally innocent on their part, but it sets you up to be a party to fraud if it isn't.

Gray Horse H/J
Mar. 18, 2012, 11:51 AM
I work for a medical billing service, not a provider's office, but I do deal with doctors' offices all day every day.

I have to say, I've never heard of the offices having patients sign a HCFA (the 1500 form). They have them sign other things - registration forms, billing waivers, HIPAA waivers, etc. But I've never seen a blank signed HCFA on file.

Regarding the box for the service facility, no insurance is going to pay on a claim where that info isn't present. They need to know where you were seen. So let's say they send in a claim without this info, with your signature on it. The insurance company is going to pend your claim and send a request for additional info to the doctor, and probably you as well. If the info conflicts with what the insurance has on file, that will also raise issues with the insurance and they will inquire about it.

Another thing to consider, let's say the office is broken into and someone steals all these blank signed claim forms with the intent of committing fraud. They'll need to know all the following info:

The doctor's name, facility address, pay-to address, NPI number, and Tax ID number, at minimum. (And if they try just making up a doctor who doesn't exist, well the insurance is likely going to question that as well. The doctor won't be in their system so they would probably ask for a copy of the doctor's signed W-9.)

The patient's name, address, DOB, insurance ID number and group number.

They would have to be able to put a CPT and an ICD-9 code(s) on the claim that actually make sense for a service that could have been done.

Claim filing is becoming much more particular as we speak. The format for filing claims has been in a changing process for awhile now.

I wouldn't worry about someone stealing claim forms to commit fraud. Fraud is way more likely to occur when a doctor decides to lie about the service they performed, or a patient tries to use someone else's insurance.

Another thing to consider, most insurance claims are filed electronically now. Do you have a large insurance company, like BCBS or United Healthcare or Humana? They discourage paper claims filing. Some very small insurance companies don't accept electronic filing, but it's rare. If the doctor you see has a decent size practice, odds are they aren't sending out paper claims anyway. It's not very efficient. Ask your doctor's office, or their billing service if they use one, how they are filing claims.

It's totally normal for the doctor to want your signature on file, so no worries there. A little odd to me that they want it on a HCFA, but I feel it'd be difficult for them to file a fraudulant claim simply because your signature is there in the office. Read all the mail you get from your insurance, any EOBs, etc. If you get an EOB for a service you don't believe you had, call the office and have them show proof.

I think you're fine. In the future, if you're asked to sign a blank HCFA or something, ask to write "Not to be used for claim filing" on it in black marker or something.

Alter4578
Mar. 18, 2012, 03:23 PM
I'm kind of confused as to why they won't do the same thing as when you sign a blank check just for a signature: write a big "VOID" across the rest of it. That way no worries about the signed form being used for any nefarious purposes.

Thank you for being confused too. :) That's why I called my insurance company, and then the NJ department of insurance. Unfortunately they did not fully answer my questions, so now I'm coming to coth to ask because Cothers rock!


I've only once had the experience of being asked to sign one. A new dentist and I stupidly signed it. Later found out he had claimed doing two thousand dollars worth of work on me which hadn't been done. Insurance paid before I found out. I was later summoned to a hearing on this dentist. Seems I wasn't the only one he'd pulled this on. Don't know if the insurance companys got their money back but he was suspended from practice for three years.

This is the sort of thing that I was afraid could happen with a signed blank claim form. But the doctor I saw has a good reputation, and that makes me worry less about him doing something that might damage his practice. It's just that it seemed odd to me, and I want to understand how common it is for doctors to ask patients to sign blank claim forms so I can take further steps to safeguard myself if I think I need to.


Hubby works in the ER and it rang his bells as a possible problem, yeah.

The whole point of your signing a 1500 is that you are testifying to validity of it. If you don't know what they have claimed, then you shouldn't be signing it. And you haven't, but they are making it look like you did.

Perhaps it is totally innocent on their part, but it sets you up to be a party to fraud if it isn't.

This is what my common sense has been telling me ever since I signed the form. How can you testify to the validity of something that isn't written yet. But then I learned that they don't file the 1500 form that I signed, and keep it in the doctors office.

But I think you're expressing my concerns perfectly when you say "but it sets you up to be a party to fraud if it isn't".

Edited to say something differently:

This is the first webpage I came across when I first started looking for information about doctors asking a patient to sign a blank form.

From the FBI website: http://www.fbi.gov/scams-safety/fraud/fraud#hcf

"Tips for Avoiding Health Care Fraud or Health Insurance Fraud:
Never sign blank insurance claim forms."

Alter4578
Mar. 18, 2012, 03:24 PM
I work for a medical billing service, not a provider's office, but I do deal with doctors' offices all day every day.

I have to say, I've never heard of the offices having patients sign a HCFA (the 1500 form). They have them sign other things - registration forms, billing waivers, HIPAA waivers, etc. But I've never seen a blank signed HCFA on file.

Thank you so much for replying. :)

What you're saying makes me think this doctors use of signed blank 1500 forms must be a rare.


Regarding the box for the service facility, no insurance is going to pay on a claim where that info isn't present. They need to know where you were seen. So let's say they send in a claim without this info, with your signature on it. The insurance company is going to pend your claim and send a request for additional info to the doctor, and probably you as well. If the info conflicts with what the insurance has on file, that will also raise issues with the insurance and they will inquire about it.

I asked the doctors office to fill in the service facility box with his name and office address. But you're saying that information would need to be on the form anyway in order to file it as a claim.

So what I accomplished by having them fill in that information was to make that form only valid for them to file a claim for their office?


Another thing to consider, let's say the office is broken into and someone steals all these blank signed claim forms with the intent of committing fraud. They'll need to know all the following info:

The doctor's name, facility address, pay-to address, NPI number, and Tax ID number, at minimum. (And if they try just making up a doctor who doesn't exist, well the insurance is likely going to question that as well. The doctor won't be in their system so they would probably ask for a copy of the doctor's signed W-9.)

The patient's name, address, DOB, insurance ID number and group number.

They would have to be able to put a CPT and an ICD-9 code(s) on the claim that actually make sense for a service that could have been done.

Claim filing is becoming much more particular as we speak. The format for filing claims has been in a changing process for awhile now.

I wouldn't worry about someone stealing claim forms to commit fraud. Fraud is way more likely to occur when a doctor decides to lie about the service they performed, or a patient tries to use someone else's insurance.

Another thing to consider, most insurance claims are filed electronically now. Do you have a large insurance company, like BCBS or United Healthcare or Humana? They discourage paper claims filing. Some very small insurance companies don't accept electronic filing, but it's rare. If the doctor you see has a decent size practice, odds are they aren't sending out paper claims anyway. It's not very efficient. Ask your doctor's office, or their billing service if they use one, how they are filing claims.

I want to try to keep names out of this thread for obvious reasons, but I think it's safe to say that I have one of the large insurance companies in NJ. When I called my insurer to tell them that I signed a blank claim form, they told me that my claim for this doctor was filed on a paper 1500 form, but not the one that I signed.

So it seems that the only risk that I've created by signing this form, centers around the doctors use of the form, and that's exactly what the NJ department of Insurance told me.


It's totally normal for the doctor to want your signature on file, so no worries there. A little odd to me that they want it on a HCFA, but I feel it'd be difficult for them to file a fraudulant claim simply because your signature is there in the office. Read all the mail you get from your insurance, any EOBs, etc. If you get an EOB for a service you don't believe you had, call the office and have them show proof.

I think you're fine. In the future, if you're asked to sign a blank HCFA or something, ask to write "Not to be used for claim filing" on it in black marker or something.

Thank you! That does help me to feel somewhat better about this.

It's also very helpful to know how to restrict the use of the form by writing "Not to be used for claim filing" on it. This makes me feel prepared in case any doctor ever asks me to sign a blank form again.

It's also very reassuring to know that I'm not the only one who thinks the doctor asking me to sign a blank form is odd.

But if I had one last question about this whole experience that I'd really like to know the answer to. It would be whether or not a signed blank 1500 form can actually serve as a document to represent a "signature on file" for filing future insurance claims?

If you read the two boxes where you write the signature, one says you are authorizing the release of medical information "to process this claim".

The other box says you are authorizing payment to "the undersigned physician".

Don't those signatures clearly only apply to the document that contains the signatures and no other?

The other principle is the one of authorization. I was not told that the claim form was going to be used to keep a signature on file, I read the signature boxes before I signed and thought they were going to use the form I was signing to file the claim.

So technically, shouldn't it be true that I never actually authorized the doctor to file claims on any other form then the form that I signed?

What's so upsetting about this for me is that I've been very ill, and I go to doctors with a sense of trust that they are going to help me get well. My mind has been literally numb from pain, and I don't need extra worries caused by doctors who use apparently "odd" claim filing systems.

The alarm bells were ringing loudly in my head when the doctor put that form in front of me and asked me to sign it. I stopped and thought about it before signing it, but I couldn't separate the trust I needed to have that the doctor was going to help me feel better, from the trust that the doctor would never ask me to sign anything that might put me at risk.

Hope that makes sense.

Rabbit351w
Mar. 18, 2012, 07:07 PM
Healthcare fraud is rampant in this country, and our insurance premiums are exorbitant as a result. Even if this doctor wasn't planning on using the form fraudulently, it makes the practice acceptable for those who ARE committing frayd. It's easy enough for doctors to defraud the insurance companies, don't help them out.

Don't ever sign blank forms. Period. For anything.

Alter4578
Mar. 18, 2012, 07:33 PM
Healthcare fraud is rampant in this country, and our insurance premiums are exorbitant as a result. Even if this doctor wasn't planning on using the form fraudulently, it makes the practice acceptable for those who ARE committing frayd. It's easy enough for doctors to defraud the insurance companies, don't help them out.

Don't ever sign blank forms. Period. For anything.

That's what I was reading while I was researching about signing blank claim forms on the internet.

Then I was sort of shocked when I couldn't find any fraud prevention information on either the state of NJ website, or the website for my insurance company.

Many other state websites, and insurance company websites, have lots of insurance fraud prevention information.

I couldn't even find any guidance on the subject of fraud prevention written in the papers I have for my insurance policy.

The best information I have so far for my questions has been what people have posted here. :yes:

tarynls
Mar. 18, 2012, 07:35 PM
No, it is not common practice. I worked for an orthopedic surgeon (also in NJ) and we never asked a patient to sign a blank form.

This is courtesy of a blog written by a California anestheologist:
( http://www.blog.greatzs.com/ :

"A doctor in Texas has been charged with the largest Medicare fraud scheme in history. Jacques Roy, MD of Medistat Group Associates in DeSoto, TX has been arrested for alleged bilking the government program $375 million over a five year span. He was charged with taking money for services that were never rendered.

The doctor and his collaborators would go door to door and offer people cash or food stamps to sign a form stating the doctor had treated them. They sometimes went as far as seeking out homeless people to get their signatures. Brazen doesn't even come close to describing this enterprise.

My question to Dr. Roy is, why $375 million? If you planned to steal money from the government, why not stop at, say, $1 million a year. Or maybe evern $5 million. In a federal Medicare budget of over $500 billion, $70 million per year may not sound like much but it will definitely start raising red, hurricane warning flags to the auditors. Couldn't he have been happy with $5 million and thereby snuck under the radar for what could have been years of a lavish champagne dream lifestyle."

Canaqua
Mar. 19, 2012, 08:42 AM
It's a bit odd. I work in IT, on a large medical billing system. We have an "Assignment of Benefits" form that patients fill out the first time they visit. All claims are then filed with "signature on file" where the patient's/represenative's signature would be. The Assignment of Benefits is saying that you authorize the insurance company to pay the provider directly for the services billed...otherwise, the check would be cut to you and you'd have to pay the provider yourself. BIG PITA. You've probably signed these things before, but didn't notice it so much when it was an AOB, rather than a blank claim form. I suppose signing a claim form and keeping it on file would work, but it is confusing for the patient. Once you've signed an AOB, claims are going to be submitted without your review or approval anyway, so I don't think the format of the benefits assignment is worth worrying about.

What you SHOULD do is review the EOBs (Explanation of Benefits) that you get from your insurance company, showing what services were billed by the provider, what the insurance company paid for them and any balance you might owe. THIS is where you'd pick up billing mistakes or outright fraud most effectively. I've never caught a provider purposefully billing for a service they didn't provide, but I've caught mistakes here and there and let the insurance company know.

amastrike
Mar. 19, 2012, 04:15 PM
We don't even have patients sign, we put "Signature on File" on it... I'm surprised the office even does that, most claims are submitted electronically and the few that aren't are usually computer printed and mailed, so no patient signatures at all.