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The Office of Inspector General (OIG), which is the enforcement arm of HHS, recently issued an Alert to physicians to exercise caution when reassigning their rights to Medicare payments. Physicians who reassign their right to bill and receive payments from Medicare may be liable for false claims submitted by the person to whom they reassigned their rights.
By way of background, Medicare pays suppliers (i.e., physicians or non-physician practitioners) for covered services if the beneficiary (i.e., the patient) assigns the claim to the suppliers, and the suppliers accept assignment. By accepting assignment, physicians agree (among other things), to accept as full paymentfor the services the amount approved by the carrier as the Medicare Part B payment (i.e., the reasonable charge or the lesser of the fee schedule amount and the actual charge), and to limit charges to the patient and other sources as required under the federal regulations.
Title XVIII of the Social Security Act prohibits payment for services provided by physicians to be paid to another individual or supplier, unless the physicians authorize such payment to be made to a permissible person. Medicare will pay the physicians' employer if physicians are required, as a condition of employment, to turn over to the employer the fees for the physicians' services. Medicare will also pay an entity enrolled in the Medicare program if there is a contractual arrangement between the entity and the physicians under which the entity bills for the physicians' services.. In either case, this is considered a "reassignment" of the right to bill Medicare and receive payment from Medicare, and in each case, the employer or entity entitled to receive payment is considered the "supplier" of the services rendered. Medicare will also pay an agent who furnishes billing and collection services to physicians or to their employer if certain requirements are satisfied, but the payment to the agent is made in the name of the physician or the employer or entity who engages the agent.
Under the reassignment rules, an entity enrolled in the Medicare program that receives payment under a contractual arrangement, and the supplier that otherwise receives payment, are jointly and severally responsible for any Medicare overpayment to that entity. Moreover, nothing in the exceptions to the prohibition on the payment to another person for services rendered by a physician alters a party's obligations under the anti-kickback section of the Social Security Act, the physician self-referral prohibition section of the Act, the rules regarding physician billing for purchased diagnostic tests, the rules regarding payment for services and supplies incident to a physician's professional services, or any other applicable Medicare laws, rules or regulations.
A recent OIG Alert encourages physicians to scrutinize employers and entities to whom they reassign their right to bill Medicare to be certain they are legitimate providers or suppliers of healthcare items and services and that they are properly billing Medicare for the physicians' services or when using the physicians' provider number.
Specifically, the OIG Alert reports that the OIG recently reached settlements with 8 physicians who violated the Civil Monetary Penalties Law by causing the submission of false claims to Medicare from physical medicine companies. In each case, the physician assigned his/her Medicare payments to a physical medicine company in exchange for a medical directorship position with such company. In such a role, these physicians did not personally render or directly supervise any services, but the companies billed Medicare using the physician's reassigned provider number claiming services were rendered by the physician when in fact they were rendered by someone else (unlicensed technicians). The OIG pursued action against the physicians and the company owners.
Under federal law, the physician (or supplier) who furnishes the service has "unrestricted access to claims submitted by an entity for services provided by that supplier." This right to access applies irrespective of whether the physician or other supplier is an employee or whether the service is provided under a contractual arrangement. If a request to provide the billing information to the physician or supplier performing the service is denied, CMS may revoke the entity's right to receive reassigned benefits.
Thus, it is important that all physicians and suppliers periodically review the billings submitted by others on their behalf, whether following a reassignment or simply hiring an outside billing company to handle the billing, because both the one to whom the billing number is issued and the one who allegedly provided the services may be liable for false or inaccurate billing for such services.
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