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Texas physician accused of improper billing

Physicians who run a private practice must balance the demands of business with the needs of their patients. In an effort to help make everything come together, these medical professionals will likely delegate duties. They may hire administrative staff to operate the front desk and help keep records organized and may hire other medical staff to assist with patient needs.

In some cases, physicians may have patients see advanced practice nurses (APNs) or mid-level practitioners. Depending on the services provided, this is a viable way to provide care and delegate duties, but billing can be tricky.

If overseen by a physician, Texas law often allows physicians to bill for these services provided by APNs at a full physician rate. If not, a different rate applies. A failure to abide by these billing rules can result in allegations of wrongdoing, as highlighted in a recent case. In this case, the government has accused a physician of intentionally bilking the government out of hundreds of thousands of dollars by inappropriately billing at the physician rate.

The prosecution claims the physician did not properly oversee the procedures and yet attempted to bill at the full physician rates. The physician agreed to pay the government over $100,000 to settle the claim. As part of the agreement, the physician does not admit any fault.

The prosecution was careful to note that there are no concerns about the quality of care provided. They believe patients received the care that they needed, they just voiced concern over the way the appointment was billed. Even so, the charges likely had a negative impact on his practice. Physicians in a similar situation can mitigate this impact by seeking legal counsel to navigate the process on their behalf and better ensure a favorable outcome.