The General Accounting Office last week urged Congress to require physician-staffing companies to enroll in Medicare so regulators can better track their billing practices, drawing enthusiasm from the industry.
"What they're acknowledging is that they're interested in learning about companies like us," said William Schumacher, president of the Schumacher Group, Lafayette, La., which contracts with 1,000 doctors in 15 states. "They now have someone to go to to access program integrity on a much easier basis," if the GAO recommendations are adopted, he said.
Under current rules, doctors and hospitals can bill the Centers for Medicare and Medicaid Services directly because they can enroll in the Medicare program. Staffing companies, however, cannot enroll in Medicare and so cannot bill the CMS for the services of their contracted doctors. Such payments are called reassigned benefits.
But they can submit claims to the CMS on behalf of their doctors and arrange for the payments that should go to the doctors to go to the staffing companies instead.
And that, the GAO report said, creates an opportunity for fraud because without records of the staffing companies, the CMS cannot track payments to them.
"Although physicians are ultimately responsible for the claims submitted on their behalf, they may not be aware of how the staffing companies code the services billed to Medicare," the report said.
In a letter to the GAO, CMS Administrator Tom Scully agreed with much of the report but said legislative changes to the practice of reassigning payments should be broadened beyond staffing companies to others that also may receive such payments.