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From Health Law Daily, February 16, 2018

Practice on the hook for reporting former employee’s felony conviction

By Rebecca Mayo, J.D.

If a managing employee leaves a medical practice, the practice is responsible for updating their Medicare enrollment information. If the enrollment information is not updated, the practice may still be responsible for notifying CMS of adverse legal action against that employee. An administrative law judge (ALJ) upheld a determination revoking Meadowmere Emergency Physicians, PLLC’s Medicare enrollment and billing privilege based on its failure to notify CMS of the felony conviction of a doctor listed on its enrollment information as a managing employee (Meadowmere Emergency Physicians, PLLC v. CMS, Docket No. C-17-495, Decision No. CR4971, November 20, 2017).

Background. In May 2016, the doctor was indicted for conspiracy to commit health care fraud, health care fraud, and aiding and abetting health care fraud. The doctor later entered a plea of guilty on the conspiracy charge. The practice where the doctor had previously been a managing employee, continued to list the doctor as such on Medicare enrollment forms. CMS revoked the billing privileges of the practice because a managing employee was convicted of a felony offense related to health care fraud and the practice failed to report the felony conviction to CMS or its contractor.

The practice requested reconsideration claiming that the doctor had not worked a shift at the practice since September of 2015 and the Medicare enrollment forms that listed the doctor as a managing employee were an administrative error. CMS issued a reconsidered determination upholding the revocation. The practice requested a hearing with the Department Appeals Board, Civil Remedies Division. CMS filed a motion for summary judgment. The practice opposed the motion and presented six exhibits that it claimed showed the doctor had not been actively working at the practice since 2015.

Decision. The ALJ refused to admit into evidence the six exhibits presented by the practice because the practice failed to show good cause as to why the practice failed to submit the evidence at the reconsideration stage or earlier. Since the practice failed to submit admissible evidence that the doctor was not a managing employee when he continued to be listed on the practice’s enrollment application as managing employee well after the date of his conviction, CMS had a legitimate basis to revoke the practice’s billing privileges.

Further, even if the practice could prove that listing the doctor as a managing employee was a clerical error, a mistake in completing the application does not absolve the practice of fault. Finally, as long as the practice listed the doctor as a managing employee on its enrollment record, even if it was in error, the practice still had an obligation to timely report his felony conviction. For these reasons, the ALJ affirmed the determination revoking the practice’s Medicare enrollment and billing privileges.

Companies: Novitas Solutions; Meadowmere Emergency Physicians PLLC

MainStory: TopStory DABDecisions CMSNews CoPNews FraudNews ProviderNews

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