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Medicare, PSCs and paperwork: The importance of reading before signing
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The next two blog entries will deal with what may be the most boring topic imaginable — paperwork. But they are important.
A few weeks ago a client called. He was being audited by Medicare through a Program Safeguard Contractor (PSC) — a private company contracted by Medicare to conduct audits. Much has been made of recovery audit contractors (RACs), but RACs are nothing special. They are one of many types of entities that can audit you. In this case the PSC sent my client a "Background Questionnaire." This multipage document seemed like a survey. It asked questions about the practice including the number of physicians employed, the number of employees, etc.
Permanent promise
The client, a physician, called me because of one particular question he was uncertain how to answer. But when I read the document, what caught my eye were some questions about medical equipment. The form asked the physician to list the brand and model of every piece of diagnostic equipment in the office. Ignoring for the moment how difficult it might be to gather that information, I focused on the paragraph that appeared right before the signature line at the end of the form. (Ok, I can't disregard how much busywork was created by this form; it was one of the most bureaucratic forms I have ever seen. I can only hope the PSC is chastised for creating it.) The paragraph stated that by signing the form, you are supposedly "certifying" that the information contained on it is accurate, and also that you will "advise" the PSC of "changes that subsequently occur with respect to any of the information provided." In other words, by signing this form, you are giving a permanent promise to the PSC that every time you hire a new employee, buy or discard a piece of equipment, or make other everyday changes to your practice, you will notify them.
Such a promise is totally unrealistic. However, since you are "certifying" it, there is at least some risk that someone can attempt to characterize your failure to keep this promise as a violation of the False Claims Act, with its attendant penalties of $5,500 per claim plus three times the amount of the claim. There would be some defenses if anyone tried to use this crazy certification to impose the liability, but anytime you have a "misrepresentation" to a government contractor, you create some risk.
Read before signing
What should you learn from this "Background Questionnaire?" Before you sign (or send) ANYTHING that goes to Medicare, or any government contractor, make sure you have reviewed the document VERY carefully. Read every single word, especially anything right above the signature line. Consider having counsel review any form that seems like it MIGHT be significant. This is particularly true when you are dealing with a RAC, PSC, or other entity that is auditing your practice. Just because a document looks like a "survey" or other seemingly innocuous document doesn't mean it can't get you in trouble.
In the case of this form, I encouraged the client to consider not returning it, and, if he did, crossing out the certification language and the promise to update the form. However, there are some forms that you must complete, and simply ignoring those forms may cause more trouble than completing it. The bottom line is that in the current climate, sadly, "forms" ARE substance.
The next entry will discuss the requirement that you report some events to Medicare. For example, you must notify Medicare if you add a partner who will own 5% or more of the practice. More on that later in the week.