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Failure to adhere to Medicare rules for supervision of tests can have consequences

Diagnostic tests generally require some level of physician supervision in order to be covered by third-party payers, including the Medicare and Medicaid programs. Although it is easy to understand the reason behind this payment policy, it can be challenging for radiologists and hospitals to determine, and then implement, the appropriate level of supervision in a particular clinical setting. Adding to the complexity is the fact that the rules governing the supervision of diagnostic tests have changed over time, as have the skills and training of the various non-physician clinical practitioners who may be involved in the delivery of these services.

Earlier this year, the U.S. Attorney for the District of Delaware announced a settlement in the amount of approximately $750,000 with the federal government to resolve allegations of health care fraud arising under the federal False Claims Act. The settlement resulted from an investigation into complaints brought to the government by a whistleblower. Over 1,500 instances were identified in which either no physician was present for studies that required supervision or it could not be determined whether a physician was present.

My fellow partner, Paul Pitts, and I have joined with our colleagues to contribute to a forward-reaching report entitled, "Outlook: US Health Care 2021." In this white paper, Paul and I explore the latest changes in Medicare's supervision rules and an outlook on the implementation of those new rules

I hope you will look for our article, and also the other important contributions from our Reed Smith colleagues as we explore the outlook for health care in the coming year.

“The regulations that apply to Medicare procedures are designed to ensure patient safety and to protect the integrity of the Medicare program,” said U.S. Attorney Weiss.  “When providers fail to comply with Medicare regulations and properly document their compliance, they undermine both the quality of patient care and the effectiveness of the program.  This office is committed to investigating and recovering payments from providers who falsely certify that they have complied with these regulations.” 

Tags

health care & life sciences, diagnostic imaging, medicare

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