Psychiatrists provide important care. Like any other form of medical care, these services are often billable to insurance companies, both private and federal. As such, the practices fall under many forms of federal and state regulations.
Four of the most important that will impact a psychiatric practice include:
- Stark law. Psychiatrists cannot refer patients for services at facilities where they, or a family member, have a financial interest.
- Fee-splitting. Psychiatrists and psychologists are generally not allowed to accept referral fees.
- Anti-kickback Statute (AKS). It is also illegal to receive kickbacks in exchange for health services reimbursed by federal healthcare programs like Medicare.
- False Claims Act (FCA). This law focuses on the importance of appropriate billing. Overbilling or using the wrong codes for claims can result in allegations of an FCA violation.
A violation of any one of these regulations can result in serious allegations of wrongdoing and harsh financial penalties. In a recent example, the government claimed a psychiatrist double-billed multiple patients. Officials gathered evidence to establish the psychiatrist submitted inflated bills for evaluation and management services as well as psychotherapy services. The government argued billing for all services in one visit was inappropriate. The prosecution pointed to Medicare rules that state providers must bill for these services separately. When faced with the evidence, the group chose to settle the claim. They agreed to pay $1.9 million to resolve the allegations.
This is just one example of the types of penalties that can come with what may seem a clerical mistake. It is important to make sure that all staff within the practice are aware of these rules and comply with federal regulations. Regular internal audits can help to mitigate these types of risks.
It is also important to note that those who face these types of allegations have options. You can fight back. An attorney experienced in this niche area of healthcare law can review the claim and help to build a defense to the allegations.
Attorney John Rivas is responsible for this communication.