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As administrative burdens and costs associated with the practice of medicine continue to grow, many physicians are wondering out loud whether now is the time to make the leap to cash-only concierge medicine.  In its purest form, concierge medicine is a model where patients pay a recurring cash fee (e.g., monthly or annual) for expedited/enhanced access to medical and wellness care.  There are many possible variations on this concept ranging from a cash fee-for-service model to a hybrid model where the physician accepts cash for some services (non-covered) and bills insurance for others. 

While the concept may sound incredibly tempting, physicians are advised to proceed with caution.  To be sure, there are a host of legal considerations - most of which have to do with Medicare and commercial insurance contractual issues.  These are particularly tricky in a hybrid model where the distinction between covered and non-covered services is critical. 

There are, however, many business considerations that should be carefully evaluated before making this leap. Among other things, the practice needs to be in a market that will support a cash-only practice. Patients who get decent coverage through their employer's plan and only have to pay minimal copays/deductibles may be reluctant to pay more. Some patients may be willing to pay for concierge level care but how many of those patients will you need to sustain a practice?  How will the practice operations and cost structure change under a concierge model?  How will the physician's lifestyle need to change?

While concierge medicine may be a great fit for a handfull of doctors, it's likely not a feasible model for many.  If you are considering making this change, be sure to do your homework first.

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Major Medicare fraud and false claims settlements against large providers and pharmaceutical and device companies are reported in the news on a regular basis these days.  Unfortunately this trend may lead many physicians to believe that their billing and collection activities are under the radar of federal and state enforcement authorities.  According to an article in the Scranton Times-Tribune, when it comes to Medicare fraud, size doesn't matter. 

According to the article, a Scranton podiatrist was sentenced this week to two years of probation and ordered to pay $23,266 in restitution for submitting false claims to Medicare.  What is significant about this case is that the podiatrist reportedly only received between $10,000 and $30,000 in improper payments from the Medicare program.  So, if you still think your practice is too small to get noticed, think again. 

The prospect of developing a full-blown fraud and abuse compliance plan may seem overwhelming for many physicians but a compliance plan is really the only "insurance" you can put in place to help minimize legal exposure from improper billing.  Consider starting small.  An annual coding and documentation audit with the help of a health care attorney and billing consultant is hands-down one of the best things you can do from a compliance standpoint and it need not be expensive.  Most importantly, however, when if comes to compliance, doing something is far better than doing nothing.  For more information on developing a cost effective compliance plan, see the article "Compliance Planning on a Shoestring Budget"www.physiciansnews.com/law/1107rodriguez.html.

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