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Reassignment of Physician Claims – OIG Special Alert

OIG Alert On Reassignment of Claims By Physicians 

The OIG recently issued and advisory alert to physicians cautioning them to exercise caution before reassigning their right to bill the Medicare program and receive Medicare payments.  Physicians may be liable for false claims submitted by entities to which they reassigned their Medicare benefits.  The OIG statements encourages physicians to use heightened scrutiny of entities prior to reassigning their Medicare payments.   The OIG alert described recent cases where physicians have been entangled in cases that were caused by third parties who improperly use reassignment authority.

OIG recently reached settlements with eight physicians who violated the Civil Monetary Penalties Law by causing the submission of false claims to Medicare from physical medicine companies. The physicians reassigned their Medicare payments to various physical medicine companies in exchange for Medical Directorship positions. While serving as Medical Directors, the physicians did not personally render or directly supervise any services. There was evidence that the services the physical medicine companies claimed the physicians performed were not actually performed or were not performed as billed.

 Other physical medicine companies falsely billed Medicare using the physicians’ reassigned provider numbers as if the physicians personally rendered the services or directly supervised a “technician” rendering the services. Many of the owners and operators of the physical medicine companies were criminally prosecuted. OIG determined that the physicians were an integral part of the scheme and pursued their liability under the Civil Monetary Penalties Law.

 As described in the OIG alert, physicians need to exercise due diligence whenever they reassign their ability to obtain reimbursement.  Physicians have the right to access billing information of the provider t0 whom reassignment is made concerning the services the physician is alleged to have performed and for which the entity billed Medicare. Physicians have unrestricted access to claims submitted by an entity for services that the entity billed using the physicians’ reassigned provider numbers.  Physicians should exercise this authority provide added assurances that the services for which the entity billed Medicare were, in fact, performed and were performed as billed.

Failure to provide this type of due diligence can expose the physician to possible penalties in the event that the reassigned provider misuses the physician’s billing rights.

View the OIG Special Alert

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John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
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