Health Law

Failing To Update Medicare Enrollment Can Spell Bad News for Physicians

By Todd Rodriguez

Many physicians are unaware that they are required to update their Medicare enrollment applications whenever key aspects of their practice change.  Changes in practice ownership, the addition or deletion of practitioners and the addition or deletion of office sites all require the filing of a completely new enrollment application.  CMS is in the process of sending notices to physicians requiring them to revalidate their enrollment information.  Failure to failure to update enrollment information on a timely basis (whether in response to a revalidation request or because of a practice change) can result in revocation of Medicare enrollment, during which time physicians are prohibited from billing Medicare at all.

When completing Medicare enrollment applications, physicians must be very careful to ensure that information is accurate and complete.  Incomplete applications can result in having the application returned for correction, which can substantially delay the process. 

Of much more significant concern, inaccurate information on enrollment applications can be deemed to be a misrepresentation with significant legal consequences.  In fact, in a recent case upheld by the 11^th Circuit Federal Court of Appeals, a medical clinic in Florida was required to refund in excess of $300,000.00 for services billed while the clinic was partly owned by a physician who had been excluded from the Medicare program.  Although the excluded physician never rendered any services on behalf of the entity or ordered or referred any Medicare services while an owner of it, the Court held that the clinic's failure to disclose the excluded physician's ownership was a misrepresentation on the enrollment application and upheld the overpayment. (see Florida Med. Ctr. of Clearwater, Inc. v. Sebelius, No. 09-13922 (11th Cir. Aug. 19, 2010).

More information regarding the Medicare enrollment and revalidation requirements can be found In the CMS Program Integrity Manual.

Full post as published by Physician Law on September 29, 2010 (boomark / email).