So far, I have not seen the government pursue these violations with the criminal and civil penalties available under the various anti-fraud-and-abuse laws. If you bill for the services of a PA under your provider number, you are claiming (explicitly or implicitly) that the service was provided either by you or by the PA as an "incident to" service.If you did not satisfy the "incident to" criteria, and submit Medicare/Medicaid claims stating an entitlement to payment for these services, you are in effect saying either that you provided a service you did not actually provide or that your support professional provided a service under conditions that were not actually present.
The "best friends" idea always sounded pretty good.
Physicians who want their practices to thrive in a managed care environment recognize that a key to success is effective delegation of responsibility.
When a support professional provides a service in a physician's office, it usually must be billed as if the physician had provided the service himself or herself.
Such services are reimbursed at the physician's rate and are known as services rendered incident to the physician's professional services.
None of this is spelled out in detail in the Medicare rules.
In many physician offices, support professionals assume much more responsibility for the treatment of patients.
The government certainly may argue that these are false claims.
Indeed, this situation also permits a disgruntled patient or former employee to pursue qui tam litigation as a surrogate for the government in pursing these violations.
To increase revenues despite shrinking reimbursement, physicians need to increase the number of patients they serve.
Until someone invents the 30-hour work day, that will require bringing in junior physicians or utilizing fully the skills of registered nurses, physician assistants, nurse practitioners and the like.
Medicare does pay specifically for services provided by a nonphysician during a minimal office visit with an established patient, even when a physician isn't present.