Corporate Compliance

Billing related to non-credentialed physicians

Compliance Monitor, January 20, 2006

Q: Our practice is credentialing a new physician with hospitals and insurance companies. This process can take up to six months for Medi-Cal and other payers. Can our practice bill for that physician's services under an existing physician in the group until the new physician is fully credentialed?

A: It is fraudulent practice to bill under one physician, when services are actually provided by another physician.

Supervisory physician's billing is permitted for teaching institutes and non-physician personnel. OIG addresses billing issues concerning supervisory billings.

Thanks to Deborah Apfel, RN, Legal Nurse Consultant, at AppleCorp, Lenexa, Kansas.


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