Physicians Urged by the OIG to Scrutinize Reassigned Medicare Claims - Physicians Still Liable Under the False Claims Act
Under Medicare regulations, joint and several (individual and shared) liability is imposed on the physician or other healthcare professional who actually provides the services as well as the entity that bills and receives reimbursement for those services under with the terms of a contractual arrangement. The healthcare provider has a duty to verify that the services were performed as billed and, therefore, must have unrestricted access to all billing and other claims information. Physicians and other practitioners must be forewarned that these requirements must be documented in writing and simply signing the reassignment form is not sufficient, and may subject the provider to liability in the event potential investigation ensues.
Notably, in an adequately documented employer-employee relationship, where the employer reserves the right to receive payments, liability under the False Claims Act for improper billings to or collections from the Medicare program is imposed solely on the employer. However, the OIG clearly stresses the fact that an employee status of the provider must be properly documented to shield that provider from False Claims Act liability. The OIG further and specifically urges all healthcare providers to “use heightened scrutiny” and “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.