CityMD case emphasizes importance of credentialing and enrollment process

The CityMD case article follows a recent announcement from the DOJ regarding a Long Island Pediatrics practice agreeing to pay $750,000 to settle similar False Claims Act allegations in respect to improperly billing services for physicians not enrolled in the Medicaid program under the NPI of a physician who was enrolled.

The basis for the CityMD case is that the multi-site Urgent Care provider billed falsely because the Medicare claim reflected an NPI of a provider other than the individual rendering the service. Per Commins (2018, May 4), "CityMD employed a number of physicians who were not credentialed with the Medicare program at the time CityMD billed Medicare for their services"

These recent cases emphasize the importance of credentialing and enrollment processes. While operationally, short cutting the enrollment process is tempting when there are clinical shifts to cover, the financial risks are significant. Partnering with a Credentials Verification Organization (CVO), like VantagePoint HealthCare Advisors, can help providers mitigate risks and stay in compliance.