Checking to make sure your new hire isn't an "excluded" provider
July 7, 2011
One of the standard contract provisions in an employment agreement is the representation that the new/potential employee have a Medicare provider number and participate with Medicare or Medicaid (used interchangeable herein). For most employers and employees the excitement involved in bringing on a new person or taking a new job overshadows some of the "smaller" details in the employment contract. We've all heard the saying "the devil is in the details", and this is a prime example of how that saying could not be more true or applicable. Taking on a new provider and allowing that provider access to your patient population, and billing for services rendered to Medicare while identifying that provider, whilst unknown to you that provider has actually been EXCLUDED from the program will open your practice up to enormous trouble. Billing for services rendered by an excluded provider is presenting a false claim to Medicare, which means that your practice would not be entitled to keep any of the reimbursement received that was performed by the excluded person. The scariest part about this hypothetical is that with the data mining being done by Medicare right now, this is a very easy thing to check, and Medicare is checking.
While this scenario does not present itself that often, it does happen and I hope this serves as a reminder to not only check the Medicare status of a future employee, but also to double check licensure, board certification, and any other "status" items your practice will require the employee abide by. For medicine, while each provider is responsible for their own medical malpractice, there is certainly plenty of administrative and financial damage an employee of a practice can do, short of malpractice.
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