Do You Pay Your Billing Agent a Percentage of Claims? You May Be in Violation of Federal law!
The Office of Inspector General (OIG) recently disseminated hundreds of recoupment letters to providers in New York who had percentage-based contracts with billing agents. OIG is seeking recoupment for services spanning a five-year period, plus 9% interest. See example redacted letter from OIG.
42 CFR 447.10 prohibits the re-assignment of provider claims and applies only to Medicaid. It is recommended that you pay your billing agent a flat fee or on a time basis.
North Carolina Medical Society also discourages fee splitting. On the NCMS website, the Society warns that “Except in instances permitted by law (N.C. Gen. Stat. § 55B-14(c)), it is the position of the Board that a licensee cannot share revenue on a percentage basis with a non-licensee. To do so is fee splitting and is grounds for disciplinary action.”
Not all States prohibit fee splitting, and if Medicare or Medicaid is not involved, then we look to state law. But if Medicare or Medicaid is involved, then federal law matters. Some States prohibit fee splitting for doctors, chiropractors, and hospitals, while other states do not prohibit fee splitting for massage therapists. So it is important to know your State’s laws.
Lawyers also have fee-splitting prohibitions. To split fees with a nonlawyer constitutes the practice of law without a license (and probably multiple other ethical concerns).
Physicians, group practices and management services organizations should continue to carefully examine their current and proposed arrangements to ensure compliance with the fee-splitting prohibition applicable to your State. If you are unsure, consult an attorney.
OIG may have started these audits in New York, but, as New York State says “Excelsior” – ever upward – we can be sure that OIG will continue across the country.
Posted on July 12, 2017, in Alleged Overpayment, Anti-Kickback and Stark law, Chiropractors, CMS, Federal Government, Federal Law, Health Care Providers and Services, Hospitals, Knicole Emanuel, Legislation, Medicaid, Medicaid Attorney, Medicaid Providers, Medicaid Reimbursements, Medicare, Medicare and Medicaid Provider Audits, Medicare Attorney, New York Medicaid, North Carolina, Office of Inspector General, Stark Law, Taxes and tagged 42 CFR 447.10, Fee Splitting, Fee Splitting Prohibition, Gordon & Rees, Knicole Emanuel, Medicaid, Medicaid Attorney; Medicaid Lawyer; Medicare Attorney Medicare Lawyer, Medicaid Billing, Medicaid Billing Agents, Medicaid Fraud, Medicaid Fraud Control Unit, Medicaid recoupments, Medicare, New York Medicaid, North Carolina Medical Society, Office of Inspector General. Bookmark the permalink. 2 Comments.