OIG Tips for Recognizing Questionable Consultants

 To safeguard themselves, physicians engaging the services of consultants should be alert to questionable practices. The U.S. Department of Health and Human Services Office of Inspector General (OIG) warns physicians to watch for promises or practices that could be problematic and trigger investigations. For example:

  • A consultant claims it is recommended by the OIG. The OIG does not recommend or endorse particular consultants or particular consultants’ services.
  • A payment specialist suggests that a client use inappropriate billing codes to elevate payment and may describe methods to avoid detection.
  • A billing consultant promises a prospective client that its advice or services will produce a specific dollar or percentage increase in the client’s Medicare payments. The consultant’s fee often is based on a percentage of the increased payments.

To make sure you are hiring a responsible consultant, check with a reputable source such as your county medical society for referrals. Ask the consultant for references and check them out thoroughly.

Or, turn to your organization, the Texas Medical Association, for help in improving your coding and billing systems and other aspects of your practice operations. TMA Practice Consulting can provide expert consultants to help you address your practice’s unique operational challenges.

To view the OIG’s complete list of questionable consultant practices, read the OIG special advisory bulletin, Practices of Business Consultants (PDF).


Content reviewed: 3/14/2007

TMA Practice E-tips main page 


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