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-   -   Possible insurance fraud (https://www.askmehelpdesk.com/showthread.php?t=253198)

  • Aug 26, 2008, 09:27 AM
    bp1star
    Possible insurance fraud
    Is it ilegal for a physician to bill and charge under his Tax ID/ NPI if a nurse practitioner is seeing the patients and at times he's not even in the office? FYI she does have her own provider numbers. Is there a way that there could be an agreement between them that would make this legal?:)
  • Aug 26, 2008, 09:37 AM
    Fr_Chuck
    Common practice, happens more often if the NP does not have an insurance provider number. But the NP works under the doctor, even if the doctor is not in the office, there is no requirement for doctor to be in the office when NP working.

    They are not requesting money not due them so there is no fraud at all

    Are you the patient or the NP? Why are you concerned ?
    Normally this will often be better for the patient esp if the NP is not under contract with the insurance company, it would save the patient a lot of money that would be due for not getting the preferred insurance pricing
  • Aug 26, 2008, 11:07 AM
    JudyKayTee
    Quote:

    Originally Posted by bp1star
    Is it ilegal for a physician to bill and charge under his Tax ID/ NPI if a nurse practioner is seeing the patients and at times hes not even in the office? FYI she does have her own provider numbers. Is there a way that there could be an agreement between them that would make this legal?:)



    Happens all the time - no, it's not illegal. It's the Physician's office and the billing comes from that office (where the NP is, in theory, employed).

    I would "assume" she's on salary. All payment go to him and he pays her. Nothing illegal at all.

    Under every law I know the Physician does not have to be present or even on the premises - he does not need to supervise the NP as she has her own license.

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