An Oklahoma physician agreed on August 28, 2017 to pay the government $580,000 to resolve allegations that he violated the False Claims Act by submitting claims to the Medicare program for services he did not provide or supervise. According to the government, the physician allowed a company that employed him and in which he had an ownership interest to use his NPI numbers to bill Medicare for physical therapy evaluation and management services that he did not provide or supervise. The government further alleged that after he separated from the company and deactivated his NPIs associated with the company, he reactivated those NPIs so that the company could use them to bill Medicare for services he neither performed nor supervised.
In the last 10-15 years, the use of mid-level providers has increased to expand the base of patients in many practices. The Nurse Practitioner scope of practice is more flexible and there are specialty designations available to foster expertise in certain areas. The insurance companies have expanded the number of plans covering a mid-level provider’s services.
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