Make Sure Your Medicare Claims Are Spot-On—or Pay the Price (Literally)

An urgent care operator in upstate New York has agreed to pay $110,000 to settle charges that it submitted false claims to Medicare. The U.S. Attorney for the region alleged that between January 2013 and October 2015 the company billed over 99% of its Medicare fees as if services had been provided or supervised directly by a physician, even though at least some of them had been provided by advanced practice providers (ie, nurse practitioners or physician assistants). Medicare pays more for visits in which a physician treats the patient, or is at least present when an advanced practice clinician provides the care. The U.S. Department of Justice has intensified its efforts to reduce levels of healthcare fraud in all practice settings. Given the important role advanced practice clinicians play in the urgent care center, however, there may be more scrutiny expected. By the same token, it may be more difficult for billing personnel to always have a clear understanding of who provided what level of care during a particular visit. It is incumbent on the provider and the operator to ensure best practices and policies support efforts to bill and code accurately—to both capture every penny earned but also to avoid any appearance of impropriety. Read more on the New York settlement here.