Forum - Questions & Answers

Mar 25th, 2014 - mellisaverheul 3 

Compliance

Is it fraud if a clinic has PA's that are not in-network and providing the service but the clinic bills with the MD that is in-network?

Mar 26th, 2014 - mellisaverheul 3 

re: Compliance

[ Is it fraud if a clinic has PA's that are not in-network and providing the service but the clinic bills with the MD that is in-network?]

I would be nice if someone could answer my question of point me in direction to find this answer.

Mar 26th, 2014 - jvosfernea 66 

re: Compliance

While I would hesitate and avoid, myself, engaging in such a practice as you describe, your question is more about legal matters. It might be better to ask a legal expert for an answer appropriate to your needs?

Mar 26th, 2014 - Mchu 39 

re: Compliance

I was hoping someone else would answer....I am not sure but would like to know. :-/

Thanks!!

Mar 26th, 2014 - Codapedia Editor 1,399 

re: Compliance

Many insurance companies do not enroll Physician Assistants, and PA's in those practices report their services under the physician's NPI. You have to check with each insurance company. Then, the person who has access to your contracts should review them.

I jokingly say, I never use the f Word in polite conversation. I urge everyone to be cautious about accusing some one of fraud.



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