Health Care Law Blog

OIG Alert – Physicians May Be Liable for False Claims Submitted by Entities Receiving Reassigned Medicare Payments

The Office of Inspector General ("OIG") for the Department of Health and Human Services recently issued an alert, which warned that “physicians who reassign their right to bill the Medicare program and receive Medicare payments by executing the CMS-855R application may be liable for false claims submitted by entities to which they reassigned their Medicare benefits.”  The OIG stressed that physicians remain liable for claims submitted using their provider numbers, even when the claims for services are submitted by another party under a contractual arrangement.  The potential for liability also exists for other types of practitioners who enter into reassignment agreements.

Medicare rules impose joint and several liability on the physician or practitioner who provides the services as well as the entity that bills and receives payment under contractual arrangements. The physician or practitioner must have unrestricted access to all billing and claims information and has an affirmative duty to verify that the services were performed as billed.  These requirements must be documented in writing.  The reassignment form is not sufficient.

The rule is different when there is a properly documented employer-employee relationship in which the terms of employment provide that the employer has the right to receive the payment.  The Medicare rules do not impose False Claims Act liability on the physician or practitioner employee in this type of employment arrangement.  Instead, the employer bears the responsibility and potential liability for submitted claims.

According to the OIG, physicians and other practitioners should “use heightened scrutiny of entities prior to reassigning their Medicare payments.”  Physicians and practitioners “should carefully consider entities to which they choose to reassign their Medicare payments and ensure that the entities are legitimate providers or suppliers of health care items and services.”

The OIG Alert is available here at the OIG website. 

Categories: Billing/Payment, Compliance, Employment, Fraud & Abuse, Medicare/Medicaid, Physicians