Mutual Matters

Billing Under Another Provider's Number Can Land Physicians in Hot Water

Posted by Emma Cecil on Nov 7, 2017 11:29:00 AM

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An Oklahoma physician agreed on August 28, 2017 to pay the government $580,000 to resolve allegations that he violated the False Claims Act by submitting claims to the Medicare program for services he did not provide or supervise. According to the government, the physician allowed a company that employed him and in which he had an ownership interest, to use his national provider identification (NPI) numbers to bill Medicare for physical therapy evaluation and management services that he did not provide or supervise. The government further alleged that after he separated from the company and deactivated his NPIs associated with the company, he reactivated those NPIs so that the company could use them to bill Medicare for services he neither performed nor supervised.

This case is yet another example of the very real risk involved in billing services provided to federal health program beneficiaries under another provider’s name and NPI number. Back in 2011, the University of North Texas Health Science Center agreed to pay $859,500 for allegedly violating the Civil Monetary Penalties Law, (“CMPL”) by submitting claims for physicians’ services provided to Medicare and Medicaid beneficiaries using the NPI numbers of 103 physicians who neither provided nor personally supervised the services rendered. Other examples include Towson University Speech Language & Hearing Center, which paid $10,000 under the CMPL for having submitted claims for audiology services with an NPI that did not correctly identify the provider who actually rendered those audiology services; a family practice physician who paid $133,880.50 under the CMPL for submitting claims to Medicare for nurse practitioner services as if he had personally performed the services; a hospital that paid $706,090.46 for violating the CMPL by submitting claims for physicians’ services provided by a doctor to Medicare beneficiaries using the provider identification numbers of another doctor, who did not further the services; and a medical school practice that paid $138,321.70 for allegedly violating the CMPL by submitting claims for physicians’ services provided by physicians to Medicare beneficiaries using the provider identification numbers of two physicians who did not furnish the services.

Discover more about the risk involved with billing under another provider's number and some key takeaways by clicking below. 

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Topics: Billing and Reimbursement

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