Wiki insurance billing on provider who owns practice

[slochbihler@ppmnow.com]

If a provider owns a practice and has one of their PA's treat them are they able to bill insurance and collect on themselves? We are feeling this is unethical as you cannot profit off yourself when you own a business but the provider feels differently.

 

[thomas7331]

If the provider has paid for their insurance policy, then they are not 'profiting off themselves' by using their benefits to obtain a service to which they are entitled under their policy - the provider employs the PA, so if they are using the PA's services, then they are incurring a cost to which they may be entitled to reibursement.

That said, this could potentially be considered a violation of self-referral laws, because providers are not supposed to refer services to entities in which they have an ownership interest. But there are a lot of loopholes and exceptions in those laws, and if it is just an isolated instance, it's unlikely to be considered a serious problem. If you are concerned about it, though, then you should ask your practice's compliance officer or legal adviser to review the situation and give their input - legal questions like this are complex and you need someone with expertise and access to the facts of the situation to get to the right answer.

 

[csperoni]

My unofficial answer on this:
Is it worth the $75-$100 office visit payment (less copay) to investigate with compliance or legal? Unless it was significant services, I would probably just not bill to insurance.
As Thomas said, it is a complex legal issue, and I wouldn't want even the possibility of an issue.