Ethical Coding and Billing

renedepuy

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Question. I have noticed that a practice is billing incident to incorrectly. They are billing under the physicians numbers (thus receiving reimbursement at a higher rate). The NP and PAs are seeing new patients and the doctor has never seen the patient at all. I have brought this to their attention that it does not meet the qualifications of incident to and is thus what I consider fraud and that they should be billing under the NP or PAs own provider numbers (which they don't have). They have advised they are working on getting credentialed and to continue to bill and code as is. What is my liability if I do this? I think since I am now aware that I am also liable. Any advice would be most appreciated while I try and make a difficult decision about this practice.
 

mitchellde

True Blue
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13,454
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Columbia, MO
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1
You may need to seek the advice of an attorney. You do know this is incorrect billing and you are billing non credentialed providers as a credentialed provider without informing the patient or the payer. If you know it is wrong and you continue to perform the function then it is wrong.
 
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