October 1, 2015
Question:

Jennifer,

I have certified DA who completed a full denture case by herself in the clinic without telling me and I heard later the practice let her do more complex cases. Her work has to be charged under a licensed Dentist.  Do I have liability here?

Thanks, 
D. L

Answer:
 
Totally depends.  If the rendering provider is not being identified properly on the billing forms, that is fraud.  If the services are properly billed with a supervising provider identified, the fact pattern may be appropriate.  

The scenario brings more questions to mind related to patient disclosure.  Are the patients aware who is actually rendering services and professional status?  

One thing is for sure, you may want to dig a little deeper to see whether you can clear concern.  Another area of issue is potential breach of contract  (in addition to the fraud) if the provider is being hidden to benefit under your name for reimbursement services.  Ex. you participate and the rendering provider does not, or vice versa.  The above are certainly not a finite list of potential areas of exposure.  Failure to properly identify a treating provider is just the tip of the iceberg compared to what the practice may be up to.  Just consider the likely upcoding!  At the same time, without all the facts, maybe they are operating compliantly?

For a productive review of particular billing scenarios and proper coding/billing, i recommend engaging a coding expert.  

Contact me for a referral if interested. 



 

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