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Urgent care centers across the U.S. treat over 150 million people for acute injuries and illnesses. As more Americans gain access to medical care through coverage under the Affordable Care Act, this number will continue to rise.
More health coverage is not the only contributing factor that has caused this increase. ER delays, fewer primary care physicians and the cost of treatment are also leading to a growing prominence in this alternative form of care.
With this increase for urgent care services comes more possibilities for billing issues. Unless caution is taken to prepare for a deluge of patients, many urgent care centers may find themselves under the watchful eye of the federal government.
Urgent Care Centers’ New Role and Legal Challenges
Monumental changes to the nation’s healthcare system has expanded the role of urgent care centers in delivering medical services. These facilities also face new challenges from legal and regulatory sources.
Billing errors, whether intentional or by mistake, can draw the attention of auditors. The suspicion of fraud and abuse raises the spectacle on these centers for something other than delivering medical treatment.
Among some of the issues urgent care centers may face are:
• Billed services that are not authorized by the Operating Certificate granted when these centers opened
• Services billed after treatment not considered a medical necessity was denied
• Not identifying the correct provider on a claim
• Using incorrect diagnosis codes
• Qualified practitioners failing to sign orders for treatment
• Explanation of services were not explained satisfactorily
Legal Issues for Urgent Care Centers
Urgent care centers that catch the attention of government auditors typically have or appear to have violated the law.
Corporate Practice of Medicine
In some states, the corporate practice of medicine is prohibited. Essentially, corporations are not allowed to employ physicians. The purpose of this doctrine is to protect the integrity of the medical profession. Corporations that hire physicians may do so with interests other than the heath of patients.
Issues raised include fee-splitting, fraud and abuse or kickbacks. Fee-splitting involves questionable financial arrangements by a physician. The federal statute governing anti-fraud and abuse requires careful analysis.
When it is determined that a physician or other medical professional was involved in a corporate practice of medicine transaction can have negative consequences for the urgent care center.
Disciplinary action for unprofessional conduct is one of the consequences. Therefore, notification that the center is under investigation should not be taken lightly.
Get Representation from an Urgent Care Lawyer
Services offered by urgent care centers are invaluable for people who want more that the traditional options for health care. Accidental errors and questionable billing practices are things to avoid.
Help from an urgent care lawyer can help these centers create a compliance plan that keeps the doors open and patients well. Protection while working through a legal issue with Medicare, Medicaid and/or commercial insurers is important to overcoming the scrutiny.
Maintaining billing practices that help these centers avoid unintentional errors is key to being available to meet the growing demand of health care services.