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Sauchik Law Group, P.C.'s attorneys

This blog is devoted to current legal and regulatory issues affecting health care providers in New York, New Jersey and nationally. We regularly publish on topics of interest to doctors, pharmacists, hospital administrators, and everyone who is interested in the current developments in the legal landscape affecting health care delivery today.

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18
Dec

Healthcare Providers Responsible for Billers' Violations of Federal and State Laws

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All healthcare providers are advised that pursuant to Section 6503 of the Federal Patient Protection Affordability Care Act (“PPACA”), all providers using third party billing companies or agencies to submit claims to Medicaid on their behalf are responsible for ensuring that those companies are properly registered and compliant with the NYS Medicaid Program as per the regulations promulgated by the Office of Medicaid Inspector General ("OMIG"). Since February 2011, OMIG has made a list of the currently enrolled billing service agencies available for general public on its website. 

To comply with the law, medical billing service companies must be registered with Medicaid and disclose their fee schedules arrangements. Despite popular belief and common practice, NYS law prohibits fee-splitting between medical practitioners and third parties. Therefore, billing/collection service agreements based on a percentage of the amount billed, collected, or any formula based on actual collections are improper. The only permitted billing collection service payment arrangement is one based on the cost and processing of the bills.

It should be noted that, as Medicaid registrants billing&collection companies are increasingly targeted for audits by the OMIG. This means that healthcare providers and billers should follow the OIG Compliance Program guidance for Third Party Medical Billing companies to make sure they do not violate any federal or state laws.

If you have any questions or need legal guidance in connection with billing service agreements or any other legal questions, please feel free to contact an experienced healthcare attorney by phone at 718-787-9500 or email at This email address is being protected from spambots. You need JavaScript enabled to view it. .

 
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