Is it acceptable to sign charts indicating the dermatologist's presence when they are not physically present for Medicare billing purposes?

Medicare Billing Fraud: Signing Charts for an Absent Dermatologist

It is absolutely not acceptable to sign charts indicating the dermatologist's presence when they are physically absent for Medicare billing purposes. This constitutes Medicare fraud and is illegal.

Medicare Requirements for Physician Presence

• Medicare explicitly requires that for billing purposes, the physician must be physically present and participating in the patient's care at the time of service 1
• As a condition of payment, Medicare requires that the medical examination of the patient be under the control of the physician or practitioner at the site where care is being delivered 1
• The patient must be present and participating in the visit, with the physician also present at the originating site when the service is furnished 1

Legal and Ethical Implications

• Signing charts falsely indicating physician presence constitutes Medicare fraud, which can lead to:

  • Accusations of billing fraud 2
  • Potential for significant fines 2
  • Possible exclusion from Medicare/Medicaid programs 2
  • Risk of criminal penalties 2

• A valid patient-physician relationship must be established for professionally responsible medical service to take place 1

• Documentation must accurately reflect the actual care provided and the providers present during that care 2

Proper Supervision Requirements

• For Medicare billing, the physician must be physically present during the service being billed 1
• When physicians are not present, there are specific billing codes and modifiers that must be used to indicate the level of supervision provided 1
• Proper documentation should include who was physically present during the encounter 2

Alternative Legal Options

• If the dermatologist is not physically present but wishes to provide care, telemedicine may be an option, but:

  • Specific telemedicine billing codes and modifiers must be used (such as GT modifier) 1
  • The patient must be at an eligible originating site 1
  • Both the provider and patient must participate in real-time interactive audio and video communication 1

• For research fellows or other providers working under a physician:

  • Documentation should clearly indicate who provided the service 2
  • Appropriate billing codes for the level of service provided by the fellow/provider should be used 2

Risks of Fraudulent Documentation

• The Office of Inspector General actively investigates Medicare fraud, including improper documentation and billing practices 2
• Nearly half of all Evaluation & Management visits for Medicare patients are coded incorrectly, making this an area of particular scrutiny 2
• Signing charts falsely could result in both professional consequences (license issues) and legal penalties 2

Remember that accurate documentation is not just a billing requirement but an ethical obligation that ensures proper patient care and maintains the integrity of the healthcare system.