The OIG is looking for “schein” arrangements for which the position of medical director is merely a smokescreen to conceal illegal payments for transfers. But it is perfectly legitimate to pay a medical director who provides really necessary services. There are a few important points that you need to keep in mind to meet the security or exception requirements described above. These points are relevant to any physician and institution that has a medical management agreement, including pharmacies and hospitals where the media director can refer patients to the company. First, the organization that hires the medical director must ensure that he or she pays fair market value for the work done by the medical director. To this end, a fair assessment of the medical director`s benefits market should be obtained. Second, the medical director`s benefits must be documented and economically adequate (i.e., the director must provide legitimate services on behalf of the employer and not perform dual or other unnecessary work). Third, the medical director must provide the employer, at least monthly, with tables of working time (or other documents used by the medical director to track the benefits provided) as a condition of payment. The medical director should use a working time certificate or other document to track the date on which he or she provided services, provide a description of the services provided and record the warmed up time for each activity.
If the transmission of working time statements for payment purposes is not necessary, payments are not paid for services that have never actually been provided. Finally, the employer must execute a written contract with the medical director and both parties must sign with a minimum term of one year. The agreement should cover all benefits that the medical director will provide for the duration of the contract. It should also determine the overall remuneration of the services to be provided and that remuneration must be consistent with the fair value of the services provided. By complying with these guidelines and requirements, medical managers and their employers can avoid possible violations of these key statutes. When a health facility receives a forgery or false medical director`s agreement to pay bribes to a physician, then all claims submitted to the government in connection with these transfers are “false allegations” within the meaning of the False Claims Act.