Pulmonology Coding Alert

Question: We had an opening at our practice for a business manager. One of the partners hired the son of his friend because the young man recently graduated college and needs a job. He said he would vouch for the candidate and that we don’t need to screen him. One of the other partners is bothered by this and wants to know if we should put some kind of system in place so it can’t happen in the future. Is that common?

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Answer: Yes, your practice should have guidelines in place about hiring, including which members of the practice are involved in interviews and decisions, what types of background checks should be performed, and what the screening process should entail. At the very least, you should run a background check on the candidate that your pulmonologist wants to hire. Although it’s unlikely that he will cost you or cause big problems, it isn’t unheard of for a business manager to create issues at pulmonary practices.

Case in point: On June 28, the US Department of Justice announced a massive fraud takedown that included an indictment against a medical clinic business manager who conspired to pay kickbacks at two practices that he oversaw, one of which was a pulmonary office. He submitted claims for diagnostic testing and other services in exchange for kickbacks from the reimbursements. The fraud activity is said to have brought in over $4 million in inappropriate charges.

You might want to share this example with your pulmonologists to ensure that they follow protocol in hiring going forward. You can read more about the case at https://www.justice.gov/usao-edny/pr/five-doctors-and-eight-healthcare-professionals-charged-part-national-healthcare-fraud.