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Providers Still Responsible for 3rd Party in Fraud Cases

Providers are responsible for fraud and abuse 3rd party billing companies filing false claims on behalf of their group or facility, a recent alert from the Office of Inspector General (OIG) reports. The OIG reminds providers to keep track of who is billing with their national provider ID number (NPI) when reassigning Medicare payments.

This is jarring news to many physicians, who in several surveys say they don't keep track of all the entities who have their NPI numbers, but new Provider Enrollment, Chain, and Ownership System (PECOS) regulations may be their salvation. PECOS is designed so a referring provider's Medicare claims can be paid. It also allows the provider to opt out of Medicare. The information gathered as part of the PECOS process defines who should and shouldn't be using the NPI. All providers must re-enroll in Medicare using PECOS, cleaning up the federal database.

Failure to manage third party use has dire consequences. The alert released by the OIG Feb. 8 uses the example of eight physicians who reassigned their Medicare payments to various companies in exchange for medical directorship positions, and were found guilty of fraud when the unmonitored services to which they had assigned their Medicare payments proved to be fraudulent.

Tags: Practice Management HHS Claims Civil Monetary Penalties Medicare Fraud Strike Force OIG Medicare Physician Reimbursement