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Posted By: Daniel Thibodeau, MHP, PA-C
December 10, 2019
As a practicing clinician, do you know what you bill for? Do you know how much is asked for in the bills that are sent to your patients? The truth of the matter is that most NPs and PAs do not even ask. There is a basic assumption that our professional colleagues are doing their diligence and appropriately billing for services within the boundaries of the rules and law. But what happens if they are not being honest? Who is at fault? The truth is that you are liable for other people's actions.
I bring up these simple questions because many of us have not given the topic much thought. It came to me as I was reading a couple of local articles related to the billing of patient services and the impact it is having on everyday people. The most recent article was in Kaiser Health News entitled, "UVA Doctors Decry Aggressive Billing Practices By Their Own Hospital." This article, by Jay Hancock, points out the stark reality of patient bills that do not get paid and the University of Virginia's aggressive legal battles to go after those bills. While the university is within its rights to bill and pursue patients for non-payment, it is important to realize that you are part of that bill and that making sure the bill is appropriate is your responsibility. According to the Centers for Medicare and Medicaid Services, fraudulent billing can lead to a prison sentence of up to 10 years and a fine up to $250,000, depending on the severity. In a recent trial in Miami, a PA pled guilty to healthcare fraud and received a hefty fine and 80 months in prison.
As a practicing PA for over 20 years, I have put my trust in my colleagues to correctly bill for services that I have given. Nevertheless, it is our duty to obey the law and do what is right, and it is also our responsibility to check in with our colleagues to ensure that appropriate practices are being followed.
- Ellison A. Ex-physician assistant gets prison time for role in $1B healthcare fraud scheme. www.beckershospitalreview.com/legal-regulatory-issues/ex-physician-assistant-gets-prison-time-for-role-in-1b-healthcare-fraud-scheme.html. Accessed December 10, 2019.
- Hancock J. UVA doctors decry aggressive billing practices by their own hospital. khn.org/news/uva-doctors-decry-aggressive-billing-practices-by-their-own-hospital/. Accessed December 10, 2019.