PHYSICIANS COMMITTING MEDICARE FRAUD THROUGH USE OF PHYSICIAN ASSISTANTS

A SKYROCKETING number of doctors offices are hiring Physician’s Assistants for cost effectiveness and efficiencies. However, recent investigations show that these offices may be committing Medicare and Medicaid Fraud because they are not in compliance with Medicare regulations.There are two types of supervision required under Medicare regulations. One applies to “incident to” services and the other to “physician services.”
“Incident to” services are those which are integral, although incidental, to a physician’s professional service that is commonly furnished in a physician’s office. The supervision requirement for “incident to” services is much more stringent than Pennsylvania law. It requires that the physician “be present in the office suite and immediately available to provide assistance and direction throughout the time the physician assistant is performing services.” However, this does not require the physician to be physically present in the same room as the physician assistant.
Physician services can also be performed by physician assistants. These are broadly defined under Medicare as “the type that are considered physician’s services if furnished by a doctor of medicine or osteopathy.” Again, the scope of these services would be limited by state law. The supervision requirement for physician services is very similar to Pennsylvania law: the physician must be immediately available for consultation purposes by telephone or “other effective, reliable means of communication.”
With the increased use of physician assistants, one can be assured that scrutiny by both state and federal governments will increase proportionally. The complexity of the Medicare regulatory scheme makes strict compliance difficult, and providers’ misunderstanding of the law has historically been a gold mine for the government. Although there are significant benefits to the use of physician assistants, the combination of governmental scrutiny and the possibility of big payouts to the government dictates a thorough review and monitoring of physician assistant relationships.