Should Hospital Employee be concerned about Unscheduled In-office Investigation?

June 28, 2012

Question:

Jennifer,

I read Tuesday's email and I have a follow up question.  I am a hospital employee.  Does this concern apply to me?  Wouldn't the Hospital be responsible or take care of any on-site investigation?

Thanks, Dr. E

Answer:

Depends.  Depends on your arrangement with the hospital.  In all likelihood the hospital has not contractually agreed to assume any and all liability based on your billing practices.  And, if you are a physician employee of a hospital with your own patients working mostly autonomously from the hospital, or even if you are a hospitalist, you are still responsible for your documentation and claims submitted.  A reviewer may very well come to investigate your documentation practices with a potential concern of up-coding, abuse or even fraud.  Just because you are a hospital employee does not insulate you from potential exposure based on your conduct.  And, the hospital will most likely not assist in any such review; you will most likely be in the same boat as you would be as a private practitioner and my same advice from Tuesday (click here for Tuesday's email) would apply. 

A rule of thumb for all practitioners, whether owner or employee or independent contractor, and regardless of who you may work for, you are the captain of your own ship with regards to your independent medical judgment and with regards to your documentation and billing (to a large degree) and if your ship starts sinking you will not find yourself in a position to hire or reassign blame to another captain.  Kapeesh?   Which is why it is so important to protect your ship, keep any potential leaks plugged (i.e., bad billers working with you, work with a coding expert, etc.) by maintaining compliance and proper policies. 

I hear from many of you that you don’t want to devote the time, energy or money to compliance, and to that I answer, okay, don’t.  Take my word for it or ignore my advice that’s up to you, however, I will again state implementing an active compliance plan now, before you are on a radar will save you hundreds of hours, tons of energy and thousands (potentially hundreds of thousands, even millions if you read the OIG website) should you be investigated later.