RED FLAGS WAVING?
While performing due diligence doesn’t guarantee a purchas- ing physician will never encounter any problems, the process does help a physician identify red flags that could signal trou- ble down the road. “Investment on the front end can help doctors avoid a night-
mare on the back end,” Mr. Kreager said. One of the most concerning possible red flags, he says, in- volves a practice that bills under one provider number for all services. This could indicate the practice is billing government or private payers for the work of a physician who’s not physi- cally present at the time of service. Mr. Kreager says physi- cians should also closely examine practices that offer ancillary services. “Physicians should approach infusion, imaging, and labora-
tory services with a greater degree of diligence. They should pay close attention to correct coding and billing for these ser- vices, as well as appropriate supervision,” he said. Practices that report inordinate revenues should also be
red-flagged, Mr. Kreager says, adding that illegitimate pain management clinics often fall into this category. “To achieve inordinate revenues means shortcuts are being taken in managing patients’ pain — mainly through overpre-
scribing without a patient evaluation or a determination of medical necessity,” he said. Ms. Robinson has also identified some red flags physicians should be aware of, including:
• The clinic’s owner isn’t a physician, as required by law, • The clinic doesn’t have any medical equipment, and • Patient charts are identical and lack documentation of a thorough medical evaluation.
“Pill mills are looking for physician names to cloak them- selves in legitimacy, and if physicians aren’t thorough, they could wind up in an unfortunate situation,” Ms. Robinson said. n
Crystal Zuzek is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email at
crystal.zuzek@texmed.org.
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