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OIG Issues Alert to Physicians Regarding Medicare Reassignment

February 8, 2012 | Comments Off on OIG Issues Alert to Physicians Regarding Medicare Reassignment
Posted by Sharlene Hunt

The Office of Inspector General (OIG) today issued an alert to physicians regarding their potential liability on claims submitted by entities to whom the physician has reassigned the right to bill for Medicare payments.  The OIG gives an example in which the OIG reached a settlement with eight physicians under the Civil Monetary Penalties Law.  These physicians had reassigned their right to Medicare payments to companies providing physical medicine services, in exchange for the physicians serving as medical directors.  The physicians did not personally provide or directly supervise any services to patients, however, the companies billed for services as though the physicians had.  The OIG criminally prosecuted the owners and operators of the companies, and pursued the physicians under the Civil Monetary Penalties Law after determining that they were “an integral part of the scheme.”

In the alert, the OIG cautions physicians to scrutinize an entity before the physician reassigns his/her Medicare payments to ensure that the entity is a legitimate provider of health care.  Any physician who reassigns his or her right to Medicare payment must complete and sign off on a CMS Form 855R. If a physician terminates the relationship giving rise to the reassignment, the physician should also file the CMS Form 855R, indicating that the previous reassignment relationship is terminated.  While the entity can file the form terminating the reassignment on its own, physicians should be proactive in this regard to make sure that Medicare has been notified when the relationship terminates.

Physicians should also be proactive by having written agreements with any entity to whom the physician reassigns his or her right to Medicare payments, giving the right to review any bills submitted under the physician’s name to confirm that services are being billed accurately.  Under the Medicare reassignment rules, with respect to the Medicare program, both the physician and the billing entity have joint and several liability for any Medicare overpayment relating to a reassigned claim.  Under these same rules, the physician has the unrestricted right to access claims submitted by the entity for services provided by the physician.


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