The Office of the Inspector General (OIG) has released a new report detailing a startling number of physician services being performed by non-physicians and unqualified non-physicians. Titled “Prevalence and Qualifications of Nonphysicians Who Performed Medicare Physician Services,” the report shows that in the first three months of 2007, non-physicians performed half of the services billed to Medicare, and unqualified non-physicians performed 21 percent of those services. The OIG sampled claims from physicians for whom Medicare allowed more than 24 hours of services in a single day. Some of the services that were performed by unqualified non-physicians were invasive services, involving entry into the body by incision or insertion of an instrument.    

In light of its report, the OIG recommends that CMS revise its "incident to" rule so that it requires that physicians who do not personally perform services billed to Medicare ensure that licensed physicians or qualified non-physicians perform the services. In order to better track services performed by non-physicians, OIG also recommends using a code modifier for any services the physician bills but does not personally perform.

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