In the ever-evolving landscape of healthcare compliance, recent enforcement trends have underscored the critical importance of accurate documentation and billing practices. A notable focus has emerged on the correlation between the time spent with patients and allegations under the False Claims Act (“FCA”). This shift highlights the need for healthcare providers to be vigilant about their documentation practices and billing accuracy to avoid legal pitfalls.
Similar to the “impossible day” scenario which government agencies are scrutinizing, there has been a slight -but significant- shift in legal theory surrounding time providers spend with patients for non-time triggered CPT codes leading to FCA violations. Specifically, the government in a District of Montana matter against an oncology provider alleged, in part, that the provider saw 50-70 patients per day, spending no more than 15 minutes with each patient and only four to seven minutes for each office visit, noting that most medical oncologists see approximately 15 patients or less in a day, leading to an allegation that Dr. Weiner failed to stay up to date with his medical record keeping and failed to provide appropriate care. In sum, the government alleges that the provider did not spend enough time with his patients in comparison with his colleagues and saw significantly more patients than his colleagues, therefore leading to scrutiny of the claim submitted for each visit, noting, in addition to other billing issues, the lack of proper documentation within the patient’s medical records. Now, with time-based CPT codes, this would swiftly fall under a “typical” impossible day scenario. However, the nuance here is that the majority of the codes at issue were complexity-based codes – (i.e. with no time restrictions).
Therefore, the significant shift in approaching FCA claims given the foregoing is that now your billing and documentation may be correct, but you are also competing with your colleagues to ensure that you are maintaining an “average” number of patients seen per day so as not to raise red flags.
Recent enforcement actions have increasingly scrutinized how healthcare providers document and bill for the time spent with patients. This trend is fueled by heightened federal oversight and the proliferation of advanced data analytics tools that can identify inconsistencies in billing practices.
The correlation between time spent with patients and FCA allegations has become a focal point in recent enforcement trends. As federal scrutiny intensifies, healthcare providers must prioritize accurate documentation and billing practices. By adhering to best practices and staying informed about enforcement trends with the assistance of knowledgeable attorneys, providers can better navigate the complex regulatory environment and mitigate the risk of FCA-related allegations. Contact Frier Levitt today to discuss a potential defense strategy for an ongoing civil investigation or to proactively evaluate compliance processes at your practice.
