c. A physician should not be guided by others when it comes to professional judgment. Many scams involve home health care business owners/medical staff companies, who pressure doctors to change the wording, change the findings, or otherwise certify homebound people who don`t meet the requirements. If there is evidence of such activity, it is a red flag and the doctor should no longer work in such a company. Unfortunately, many unscrupulous health care facilities try to circumvent the Stark Act and the anti-bribery law by hiding bribes in the form of fake agreements for medical directors. The system usually works as follows: Doctors should be very careful when entering into agreements with home health/medical staff companies. Even an employment or medical director agreement that appears to be properly drafted does not protect a physician from the problems described above. Invoking ignorance is not a defense, and every doctor has a responsibility to ask questions and be aware of the companies in which they are involved, so as not to unknowingly help carry out fraudulent activities against Medicare or other payers. 3. Physicians need to pay attention to systems where their digital signature is used and applied to medical records they haven`t verified, fill out prescriptions for patients, or involve the doctor in the business more than they actually are. A doctor must know and understand how their NPI/DEA and information is used by third parties.
If a health care facility enters into a false or bogus agreement through a medical director to pay bribes to a physician, any claim made to the government in connection with those referrals is a ”false statement” under the False Claims Act. Whistleblowers who report false agreements with medical directors could be entitled to a reward based on a percentage of damages recovered by the government. Providers and physicians, particularly in the post-acute and long-term care industries, must ensure that medical leadership positions are closely monitored and adequately documented. Please contact Rob Heath or your Lawyer Reinhart if you have any questions about exposure to liability related to your Medical Director contract, or if you would like assistance in drafting a new Medical Director Contract or revising your existing Medical Director Contract to meet all current requirements and qualify for the Safe Harbor of the Personal Services and Management Agreement. For most health facilities, the lifeblood of income is referrals from doctors. This provides a strong incentive for healthcare facilities to offer bribes to doctors in exchange for referrals. For this reason, federal health laws, including the Stark Act and the Anti-Bribery Act, have introduced a variety of prohibitions to ensure that doctors make referrals in the best interest of the patient and not in the best interest of their own paperbacks. 2. Physicians should be careful not to sign forms indicating that they have participated in the supervision of the care plan (CPO) for a physician`s visiting company, unless they have actually provided the services. The OPC usually involves monitoring a patient receiving home care services and is a time-based service. Medicare requires that at least 30 minutes per month be spent by a physician billing the CPO (other payers have different policies), services such as physician development and/or review of care plans, review of subsequent patient status reports, review of laboratory studies, and other related studies, and communication with other healthcare professionals involved in patient care. contain.
CPO services cannot be billed if they are provided by office staff, and follow-up time must apply to activities actually provided by the physician. Unfortunately, many physicians are not familiar with the requirements of CPOs and regularly sign pre-filled CPO forms that are completed by employees in violation of billing requirements. CPOs are an area where recent investigations have multiplied across the country, and many doctors have been investigated and/or charged due to signing CPO forms for services not provided.  Under the False Claims Act, health care providers may be held liable if they (a) submit or have knowingly submitted a false or fraudulent claim for payment or approval; (b) knowingly make, use or cause a false record or misrepresentation to be made or used as a false or fraudulent claim; or (c) conspire to oppose the False Claims Act. 31 U.S.C§ 3729(a)(1)(A)-(C). For example, the Florida-based Hebrew Homes Health Network (”Hebrew Homes”) agreed to pay $17 million to settle allegations that it violated the False Claims Act by improperly paying doctors for referrals of medicare patients who need qualified care.  Over a period of about seven years, Hebrew Homes hired many physicians to serve as medical directors under contracts that specified work tasks and hourly requirements. Hebrew Homes signed contracts with several medical directors at the same time. The physicians were not performing the activities required of them under their contracts. The Justice Department claimed that doctors were paid for referrals to Hebrew homes because referrals increased exponentially after doctors were on the payroll of Hebrew homes.
Home health agencies and home visiting companies are employers that doctors should turn to with great caution. Many post-acute and long-term care providers who have entered into dubious agreements with medical directors have also reached significant settlements over the past year. In many cases, the Office of the Inspector General and the U.S. Department of Justice (”DOJ”) have asserted that the compensation paid to physicians constitutes unreasonable compensation within the meaning of the Anti-Bribery Act because the payments took into account the volume or value of the referrals, did not reflect the fair market value of the services to be provided, and the physicians did not actually provide the agreed upon services. Regardless of the environment in which a medical director provides services, it is essential that the physician and the provider unit that pays the physician enter into an agreement that sets out the services to be provided by the physician (”Medical Director`s Agreement”). Failure to enter into an agreement on a medical director or to enter into a deficient agreement on a medical director can result in significant liability for both parties under fraud and abuse laws, including the Federal Bribery Act, the Stark Act and the False Claims Act.  Significant problems can arise for both individual physicians and providers due to questionable payments or compensation above market value. I recently had a doctor come to my office and asked me for advice on his private practice. The doctor told me that he also spent a few days a week working at a doctors` home visiting company, where he served as medical director, reviewed documents, and supervised mid-level providers. Although this was not the purpose of his visit, during my discussion with him, I became extremely concerned about his activities with the doctor`s home visiting company, and we finally ended our meeting with serious issues that were further discussed and discussed. Physicians play a crucial role in the post-acute and long-term care industry.
Physicians who act as medical directors determine whether individuals are eligible for palliative care or home health services. Their task is to implement the residents` care policy and coordinate medical care in qualified care facilities. Physicians often play a dual role of medical director and attending physician for many qualified nursing physicians. d. A physician should certify patients who do not or no longer meet the requirements of the home. The pressure not to be certified by an employer should also be seen as a red flag. From the point of view of the health facility, paying incidental expenses to medical directors, that is, bribes, can be very profitable. The health care facility will make much more money by charging Medicare for new patients than it pays the doctor in fake medical director fees. Of course, not all agreements on medical directors are bribes. The government has issued various regulations to determine whether an agreement on a medical director is considered a valid employment relationship. In general, for an agreement to be valid, it must meet the following requirements: a.
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