| As compliance professionals, the concept of an “unlikely” physician day is not a new risk area. Conducting data analysis of time-based services to identify instances where billings frequently exceeded a set number of hours per day has been commonplace in most organizations for many years. However, with the change in evaluation and management (E/M) services in 2021 from average times to minimum times, some organizations have abandoned this analysis while others have taken a more lenient approach when evaluating daily billing volumes.
Recently, the Department of Justice (DOJ) filed a False Claims Act (FCA) case against a physician who routinely scheduled and billed for 50-70 patients per day. The complaint alleges the physician spent only 4 to 7 minutes per patient which allowed little time for the physician to review patients’ medical histories, diagnose illnesses, prepare treatment plans, and properly document in the medical record.
The case was filed by the DOJ after the hospital who employed the physician separately agreed to a $10 million dollar FCA settlement. The complaint also indicates the physician was compensated on a RVU model and the patient scheduling practices were done in an effort to maximize reimbursement.
The case is a good reminder of the need to conduct routine analysis of daily billing volumes in addition to other utilization analysis. Outliers should be audited to determine the appropriateness and quality of the services provided.
The HBE team of experts is available to assist you with all aspects of your compliance program needs.
The full complaint is available at:
https://ewscripps.brightspotcdn.com/44/55/f9db0b174263ab5bd3d3bf3cd283/weiner-complaint.pdf |
