Ripped From the. PAs and NPs in the News

Transcription

1 Ripped From the Headlines: PAs and NPs in the News NCF 2017 San Diego

2 2

3 3

4 4

5 PAS & NPS: TOP 10 BEST HEALTHCARE JOBS OF

6 Demand The Medicus report bolsters findings from rankings by rival firms like Merritt Hawkins, a subsidiary of AMN Healthcare Services (AHS), which has also shown PAs along with nurse practitioners more in demand than certain medical specialties.

7 Most Difficult-to-fill Healthcare Positions 1. Physicians 2. Surgeons 3. Registered Nurses 4. Physician Assistants 5. Nurse Practitioners Healthcare Recruiting: High demand with a short supply! Talent Acquisition Excellence Essentials presented by HR.com

8 High Demand-Short Supply Another major change to recruitment is considering a different skill set to fill difficult-to-fill roles. One example is hiring a Nurse Practitioner and/or a Physician Assistant as an alternative to hiring a Physician. We all need to think outside the box in order to meet our hiring objectives. Healthcare Recruiting: High demand with a short supply! Talent Acquisition Excellence Essentials presented by HR.com

9 9

10 Physician Leadership Journal January/February

11 AHLA Connections August

12 AHLA Connections November

13 Fraud Allegations 13

14 Source: Dept. of Justice Presentation/HCCA Compliance Enforcement Conference, October

15 Penalties increased Effective August 1st See 81 Fed. Reg. 26,127 (May 2, 2016)

16 JUNE 2016

17 Home Health Falsification of medical records Upcoding Cloning/copy & paste 17

18 MD2U required non-physician providers (NPPs) to document that patients were homebound or homelimited and indicate in the medical record that an outpatient visit would jeopardize the patient s health, regardless as to whether this was true or not. A number of MD2U patients were neither homebound nor home-limited, as some patients worked outside the home, attended school outside the home, drove independently, routinely saw other providers in the office and in at least one case, went horseback riding. MD2U would require NPPs to perform medically unnecessary visits and improperly bill Government Health Care Programs for evaluation and management (E&M) visits in order to generate revenue. Management instructed NPPs to schedule patient visits more frequently than necessary in order to increase productivity. According to a review of Medicare claims submitted by MD2U between July 1, 2007, and Nov. 30, 2014, 98 percent were falsely billed to Medicare. NPPs patient visits would often last less than ten minutes with some lasting less than five minutes (and in at least one reviewed case 34 seconds), but these encounters were billed as comprehensive medical visits and billed at the highest level E&M code possible. The American Medical Association s guidelines for these codes indicate that practitioner s using the codes billed by MD2U should be performing comprehensive medical exams and should typically spend 60 minutes face-to-face with the patient, family member or caregiver. Management trained NPPs to bill all visits using the highest level E&M code available. MD2U also utilized an electronic medical records (EMR) system that permitted the NPPs to easily electronically cut, copy and paste medical notes from prior visits. The ability to migrate notes from visits that occurred weeks, months, or even years prior to the current patient encounter created the illusion that MD2U s NPPs were performing a significant amount of work during their patient encounters when, in fact, they were not. If the documentation was deficient to bill the highest level code, MD2U would direct NPPs to go back and change the medical record after the encounter had occurred to falsely show that more work was performed during the visit in order to support the highest level billing. 18

19 Settlement Through a stipulation and order to be entered by the court, the defendants have admitted that they violated the False Claims Act, 31 U.S.C , by (a) making or causing others to make false statements and (b) submitting or causing others to submit false claims to the United States. The defendants admit that these actions caused damages and that they are liable to the United States in the amount of $21,511,756 under the False Claims Act (which allows for damages in the amount of three times the government s loss, plus penalties). 19

20 The settlement resolves allegations that from January 2008 through February 2015, Dr. Rice, by and through UMCP, billed Medicare and Medicaid for in-person evaluation and management services at the higher physician fee rate, even though the services were often provided by non-physician providers. 20

21 In the qui tam complaint, the whistleblower alleged that the defendants submitted claims to the federal government to receive reimbursement for services performed by non-physicians as incident to the services of supervising physicians when, in fact, supervising physicians were away from the office or otherwise incapable of supervising. Billing services as incident to a physician s supervision commands a higher reimbursement rate than billing those same services without physician supervision. Because physicians were not available to provide the supervision that the government programs required, the whistleblower alleged that defendants incident to billing was improper and resulted in false claims during the period from July 1, 2007 through December 31,

22 Specifically, Tucker routinely billed Medicaid for more complex office visits than were actually provided. In addition, Tucker routinely billed both Medicaid and Medicare for the services of physicians when the patient had actually been seen by a nurse practitioner. In each of these instances Tucker s conduct resulted in his clinics receiving greater reimbursement than they were entitled to from Medicaid and Medicare.

23 Assisting at Surgery

24 Concurrent Surgery Shred 2 Shred 3

25 Pending Case: Failure to Meeting Teaching Hospital Rules when Qualified Resident Available 25

26 Source: Department of Justice 26

27 Calls from the Field 27

28 Survey/Mock Survey/Survey Prep Critical Access Hospital: Rapid Sequence Intubation/Use of Etomidate and Succinylcholine by a PA. Academic Medical Center: Nurse Practitioner written agreements EMTALA and Medical Screening Exam Surgeon presence-ability to be absent when PAs/NPs first assisting. Informed consent. FPPE/OPPE 28

29 Chlm.org 29