Quit my job

[Mcmtg]

help! I'm an NP who's just put in one year of family practice (no contract, hourly pay) at a small clinic. After doing an online seminar a few days ago I learned that I have a right to review billing statements and that I should be reviewing them regularly to make sure they are correct, especially incident-to billing. The doctor and billing manager would not let me see them (in truth, they just did not respond to my request or concerns).

So, I quit the next day (no prior notice...recall that I had no contract) after much internal turmoil! Why? Because I fear they are not familiar with incident-to rules...and have likely been billing incorrectly for the past 6 months that I've been credentialed with CMS. I have never been involved in the billing process...they've kept me in the dark. I have no patients of my own as all have the doctor as PCP.

My thinking was that if they won't address my concerns they probably have something to hide; I figured that if I stayed one more day then my suspicions could/would be confirmed... then I'd have to report fraud, or be indicted for continuing to work there/gaining financially from the fraud.

Quitting immediately before learning anything more spared myself or the practice from going down that ugly road. I've never seen evidence of fraud...only blank stares whenever I'd mentioned that there are specific rules to follow when billing incident-to with an NP on staff... That's never a good sign...right? (I was the first NP at this practice).

Any thoughts or similar experiences?

[guest416560]

I've left more than a handful of jobs over the years but never with just one day notice even if I thought something was fishy. Your future employer may want to know why you gave just one day's notice out of fear that you may do the same to them. Even if you think there is fraud going on it is just a professional thing to do to give at least two weeks notice.

In regards to billing, you can always contact your Medicare contractor which is probably Noridian and speak to a representative there if you are concerned regarding incident to billings. They are usually very helpful. You will need to have your TIN number on hand along with your Medicare billing number.

[meanmaryjean, DNP, RN]

Wow! Quitting with no notice because you didn't get an immediate response without trying other avenues?

Good luck securing your next position.

[Mcmtg]

I appreciate your response. I've seen colleagues go bankrupt or jailed following failed Medicare audits ... One good friend was fined in the millions and had to close her practice because of unintentional billing errors. I'm aware of at least one who was found guilty because he continued to work in the office despite suspicion of fraud. He was accused of gaining financially from the fraud because he continued to work there and collect a paycheck. According to the court documents he said he was afraid to quit because he'd be breaking his contract and would have to pay the doctor $15,000 per terms of the contract. He lost his license to practice for 10 years and has to make restitution to the tune of $100,000.

In my case I'd provided information to the physician on more than two occasions over the past 5 months about this issue but was summarily 'shut out'/not taken seriously...including suggestions that we self-audit and make any corrections. Never received a response or acknowledgement (going back 5 months, mind you).

[Mcmtg]

Thanks for the 'heads up'. I've got no unrealistic expectations...I plan to do my research much better the second time around. I also plan to be very upfront about my concerns related to the billing process and office safeguards to prevent billing errors/self audit process and so on. Hopefully you had a chance to read my response to the first comment above as it provides a bit more context to the situation. This was not a 'one and done' notification to the physician.

[Oldmahubbard]

I would like to know more about the million dollar fines, and loss of license over minor issues for these totally innocent people.....not my experience, and sounds a lot like an urban legend.

The people I have known of who got in trouble, deserved everything that happened to them.

That being said, I think there are illegal billing schemes that people can fall into. The rules are pretty clear about "incident to" and the standards are very high, compared to the minor increase in billing.

[Mcmtg]

Career Code Red: Unintentional Medicare Billing Fraud | Clinician Reviews

The link is to an article that offers some clarity on the issue. Please read the entire article to get a full understanding. The problem is more widespread than you may think.

[Jedrnurse, BSN, RN]

Well, you worked there for over a year and suddenly the danger to your practice was so great that you quit with no notice? There's a good chance that this will come back to bite you...

[Rnis, BSN, DNP, APRN, NP]

Are you even doing incident to billing??? (it has nothing to do with who is listed as the pcp) That is not something we ever do where I work. That being said, I think your reaction is really bizarre. Even if you have real concerns I think quitting in such a manner does not reflect well on you for anyone.

I work at a large organization and my billing is looked over by coding and I am audited regularly to ensure I am billing correctly. I feel very supported and aware of expectations with coding..... I can understand where that would feel overwhelming if I hadn't been given training or communication in these areas...... but the first step is requesting a meeting (and giving the a week or 2 to comply).

[mmutk, BSN, RN, EMT-I]

Well if Medicare issues do come up at that practice now you can consider yourself thrown under the bus. I have no doubt they will use you as a scape goat if necessary because you just up and left them.

[Riburn3, BSN, MSN, APRN, NP]

Well, you worked there for over a year and suddenly the danger to your practice was so great that you quit with no notice? There's a good chance that this will come back to bite you...

So much this! It's definitely good to stay on your toes and your physician should have had no problem sharing these things with you, but the way you quit is terrible. Explaining this to future employers will likely generate a similar response, especially when you could have contacted your medicare contractor before jumping to conclusions.

[ghillbert, MSN, NP]

This seems extremely impulsive and unprofessional to me. You didn't get a reply so quit without notice although you have no evidence of incorrect billing because... well... you didnt give them a chance to reply. Very odd.