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Physicians: Exercise Caution When Reassigning Payments

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  • In Audit
  • February 10, 2012
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An alert issued Feb. 8 by the Office of Inspector General (OIG) warns physicians of their liability for false claims submitted by entities receiving reassigned Medicare payments.
To hit this point home, the OIG cites in the alert of a recent case where eight physicians who reassigned their Medicare benefits to various physical medicine companies violated the Civil Monetary Penalties Law “by causing the submission of false claims to Medicare.”
“The failure of the physicians to monitor the services billed using their reassigned provider numbers resulted in individuals with little to no medical background serving as physical therapy ‘technicians,'” the OIG said. Based on this, the OIG determined the physicians were an integral part of a scheme to defraud Medicare.
According to a 2009 OIG report, 77 percent of practitioners had at least one reassignment of their Medicare benefits in 2007. Of those reassignments, practitioners indicated that 37 percent should not have been active; however, 29 percent said that they never update, did not know how to update, or relied on others to update their contract information with Medicare.
Forty-eight percent of practitioners indicated to the OIG that they did not know they were entitled to access claims billed on their behalf.
In fact, a physician who reassigns his or her Medicare benefits to a third party has the right to access the entity’s billing information. Physicians legally have unrestricted access to claims submitted by an entity billing under his or her provider number.
In addition to monitoring entities to which practitioners reassign Medicare benefits, the OIG also recommends physicians use heightened scrutiny, carefully consider entities, and ensure entities are legitimate providers or suppliers of durable medical equipment.
Read the OIG Alert for complete details.

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