MSSNY PULSE

A recent $600,000 False Claims Act settlement between the United States Department of Justice (“DOJ”) and an Orange County healthcare practice serves as a critical reminder of the importance of proper credentialing and supervision of providers. The settlement arose from allegations that the practice had billed Medicare and Medicaid for services rendered by non-credentialed providers and, in an effort to hide their conduct, falsified patient records to justify these claims.  The related DOJ press release can be found at Southern District of New York | U.S. Attorney Announces $600,000 False Claims Act Settlement With Medical Practice And Its Owners For Improper Medicare And Medicaid Billing | United States Department of Justice.

For physicians, the settlement underscores the importance of ensuring that every healthcare provider in your practice is fully credentialed and meets the necessary qualifications before delivering services that will be billed to government healthcare programs. Of course, commercial and private insurance plans have similar credentialing requirements that physicians need to be aware of as well. Physicians are encouraged to consult with legal and credentialing experts to ensure their practice is in compliance.

Credentialing is not merely an administrative task but a legal requirement. Failing to properly credential a provider or allowing certain mid-level providers to render services unsupervised can be deemed fraudulent, as seen in this case. This could not only result in significant financial penalties but, in more severe cases, also revocation of billing privileges and even criminal referral.

Moreover, the settlement highlights the dangers of altering patient records. In this case, the offending practice altered patient records to reflect falsely that a particular physician had seen a patient when, in fact, the patient had been seen by a different provider altogether. Falsifying records, whether to justify billing or for any other reason, can lead to severe legal consequences, including insurance overpayment actions as well as license revocation.

To avoid these pitfalls, it’s essential to implement and regularly audit a robust credentialing process within your practice. This includes verifying that all providers are properly credentialed and maintaining strict documentation standards. Regular internal audits can help ensure that your practice complies with all relevant laws and regulations.

If you have any questions about this matter or need assistance with credentialing and compliance in your practice, please feel free to reach out. Ensuring that your practice adheres to the highest standards in these areas can protect you from legal repercussions and maintain the trust of your patients.

For further guidance or assistance, please contact David N. Vozza, Esq. at [email protected] or call (917) 369-8867.

More doctors are stepping into the political arena, driven by the desire to impact healthcare policy and their communities. Physician-elected officials emphasize the importance of having clear motivations, getting educated on the political process, and starting locally, such as serving on school boards or town councils. They encourage their peers not to be intimidated by politics and to make time for public service while continuing their medical careers. Although the path can be challenging, with potential disappointments and the need to learn new skills, these physician-politicians believe that their medical background uniquely equips them to lead and advocate effectively. Whether you win or lose, or even choose not to run, your role as a doctor already positions you to lead and influence your community. Read the full article to learn more about the journey of doctors in politics and how you can get involved.

Thinking About Running for Office? (Payerchin, Medical Economics, 8/24).

Be a Voice for Change: Shape MSSNY’s 2025 Legislative Agenda! Take a few minutes to complete our survey and share the issues that matter most to you as a physician. Your input is vital as we prepare for the upcoming New York State legislative session.

Take an active role in shaping the future of your profession—join a MSSNY Committee today! This is your opportunity to make a real impact, collaborate with peers, and bring your unique perspective to the table. The deadline to sign up is Monday, September 30, at 4:00 PM. Don’t miss your chance to influence key issues and help advance the medical community. Submit your Committee Volunteer Form now and be a part of the change you want to see.

Join the New York State Department of Health for the September 11th Commissioner’s Medical Grand Rounds from 12:00 PM to 1:00 PM ET.

This session will focus on critical updates in STI prevention, featuring expert speakers covering topics like HIV PrEP advancements, doxycycline for bacterial STI PEP, and recent STI trends in New York. Healthcare professionals can gain the latest tools and knowledge to improve patient care related to HIV and STIs. Registration is free for physicians, and certificates of attendance are available for submission to accrediting bodies.

Mark your calendars for an unforgettable evening at the Red Lantern Gala on Saturday, November 2, 2024, from 6 PM to 10 PM at Pier 60, Chelsea Piers. Early bird pricing is available until September 30—save on individual tickets and tables by securing your spot now. This event supports the incredible work of the Chinese American Medical Society (CAMS) and Chinese-American Independent Practice Association (CAIPA) while offering a night of fine dining and networking.

Explore sponsorship opportunities from Diamond to Silver packages and showcase your company to a prestigious audience. Sponsorships include gala seating, advertising, and exclusive speaking opportunities during the CAMS Annual Scientific Conference.

Learn more, purchase tickets, or become a sponsor here. Don’t miss out!

Get ready for an exciting experience with Healthcare Appreciation and Hockey Fights Cancer at MSG! These special games include the thrill of the action and a $15 food and drink credit with your ticket. Don’t miss out—tickets are expected to sell out fast!

For more details or to secure your tickets, contact Paul LoFaso at MSG Sports Group Sales. You can reach him by call or text at (212) 631-5598 or at [email protected].

MSSNY members: Don’t miss out on exclusive deals for all remaining Mets and select Yankees home games as both teams chase spots in the playoffs! Enjoy 20% off tickets for all Mets home games and save up to 50% on select Yankees games. Use code MSSNY to grab your seats and be part of the action!