Teamhealth Suit

[Groove]

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I saw this posted on Reddit today. It looks like it was filed in 2/20. Anybody know what the outcome of this was? It would have pretty big implications if TH lost. Pretty much any CMG I've worked for has required signature on MLP charts and billed the case under the physician NPI so they can bill 100% instead of 85% under the MLP NPI. If they lost this it would dramatically change how they bill for MLP charts where the physician has never seen the pt. I've often had an issue with this because MIPS fallouts get applied to my NPI if they miss something which I've always thought was unfair. I have less of an issue with the CC billing. The plaintiffs claim there is a CC quota mandated for the physicians and I've never had anyone require me to bill a certain CC. However, it does give me pause to make sure I'm billing for cases that qualify for CC. There was a scribe on the thread that claimed he was contacted by the FBI a few months ago to be questioned on how they chart/document for the physicians.

United States of America et al, Ex Rel. Caleb Hernandez & Jason Whaley, Relators v. Team Health Holdings, Inc. et al: MEMORANDUM OPINION AND ORDER re 85 MOTION to Dismiss Relators' Second Amended Complaint filed by Ameriteam Services, L.L.C., QUANTUM

United States of America et al, Ex Rel. Caleb Hernandez & Jason Whaley, Relators v. Team Health Holdings, Inc. et al: MEMORANDUM OPINION AND ORDER re 85 MOTION to Dismiss Relators' Second Amended Complaint filed by Ameriteam Services, L.L.C., QUANTUM PLUS, L.L.C., (d/b/a TEAMHEALTH WEST), Team...

www.docketbird.com

 

[Groove]

Corresponding reddit thread:

 

[Birdstrike]

Whoever blew the whistle on this (likely a disgruntled employee) is entitled to 15-25% of however much money the government can get. That could be a tremendous amount of money if TH loses this case.

Here's recent one where an Urgent Care was hit for $22 million. The whistleblower is due $5.4 million.

 

[Birdstrike]

looks like it was filed in 2/20. Anybody know what the outcome of this was?[/URL]

PS: These cases can take years.

 

[GeneralVeers]

I'd love to do a whistleblower for EKGs at a certain facility I worked for. EKGs not ordered by a physician, and ordered unnecessarily by "protocol" then billed to the patient or medicare.

 

[Siggy]

One thing to remember is that you can't split/share critical care time with midlevels.


"3. NPP time and physician time cannot be combined to calculate a primary critical care E/M service.
Example: An NPP is called urgently to the surgical intensive care unit for a patient in respiratory distress on extracorporeal membrane oxygenation. The NPP provides 40 minutes of critical care to stabilize the patient. The physician arrives, examines the patient, reviews the findings, and spends 18 minutes providing full attention to the patient."

SCCM | Nonphysician Practitioner Billing

Learn about billing and coding for the nonphysician practitioner.

www.sccm.org

 

[southerndoc]

Simply cosigning the chart doesn't entitle you to bill at 100%. You have to see the patient.

 

[Groove]

Simply cosigning the chart doesn't entitle you to bill at 100%. You have to see the patient.

Yeah, but you work for the same CMG I used to work for and check your MIPS fallouts. They are billing the chart under your NPI which is why the MIPS fallouts for MLP charts get applied to you.

 

[southerndoc]

Yeah, but you work for the same CMG I used to work for and check your MIPS fallouts. They are billing the chart under your NPI which is why the MIPS fallouts for MLP charts get applied to you.

Odd. Ours are separated. We even get breakdown by resident vs. attending alone.

Goes to show we aren't like the big CMG's. Each shop is still run pretty much individually.

 

[Groove]

Odd. Ours are separated. We even get breakdown by resident vs. attending alone.

Goes to show we aren't like the big CMG's. Each shop is still run pretty much individually.

Weird. Both of our sites in my area had MLP charts billing under the physician. I wonder if your state has anything to do with it or the fact that you have a residency. I suppose it could be just us but the charts were billed that way when I worked for Schumacher, Apollo and TH, at least in my regional area. Multiple hospitals. I think this type of billing is much more the norm than the exception in the CMG world.

I'm almost afraid for them to get shut down on this practice as it would provide yet again....another reason to cut costs by reducing pay for the physicians. By the same token, I've never really understood the requirement to sign each and every MLP chart, especially on patients that I haven't seen. Even in supervising physician states like mine, only 20% chart review is required.

 

[Birdstrike]

Weird. Both of our sites in my area had MLP charts billing under the physician. I wonder if your state has anything to do with it or the fact that you have a residency. I suppose it could be just us but the charts were billed that way when I worked for Schumacher, Apollo and TH, at least in my regional area. Multiple hospitals. I think this type of billing is much more the norm than the exception in the CMG world.

I'm almost afraid for them to get shut down on this practice as it would provide yet again....another reason to cut costs by reducing pay for the physicians. By the same token, I've never really understood the requirement to sign each and every MLP chart, especially on patients that I haven't seen. Even in supervising physician states like mine, only 20% chart review is required.

So they can bill that extra 20%

 

[GeneralVeers]

So they can bill that extra 20%

Also to share the liability. I had to go in front of the Texas board for inadequate supervision when one of my PAs messed up a "fast track" patient which I never saw.

 

[Birdstrike]

Also to share the liability. I had to go in front of the Texas board for inadequate supervision when one of my PAs messed up a "fast track" patient which I never saw.

That's right. Get a doc to cosign so they name "PA + doc" instead of "PA + CMG corp."

 

[southerndoc]

My health system has a policy that all ESI 1-3 patients seen by a PA/NP must be seen by the physician as well. PA/NP's can manage ESI 4-5 patients without the physician seeing, but we're still required to cosign their chart.

@GeneralVeers patient sounds like an ESI 4.

 

[EM Junkie]

I'd love to do a whistleblower for EKGs at a certain facility I worked for. EKGs not ordered by a physician, and ordered unnecessarily by "protocol" then billed to the patient or medicare.

Except that protocol is signed by a physician, thus technically a physician order right?

 

[GeneralVeers]

Except that protocol is signed by a physician, thus technically a physician order right?

True, but when they order for things outside of thr protocol, like asymptomatic HTN it becomes fraud.