Audit red flag: Treating a family member or yourself, and billing for it

Issue: BCMJ, vol. 60 , No. 3 , April 2018 , Pages 174 Billing Tips

In 2014 the Patterns of Practice Committee published the following information about physicians billing for family members or themselves. Despite this, there continue to be incidents of physicians treating and billing for family members or themselves.

Physicians are reminded of Preamble C. 19 of the MSC Payment Schedule and the Doctors of BC Guide to Fees, which states: 

1.    Services are not benefits of MSP if a medical practitioner provides them to the following members of the medical practitioner’s family: 
a. a spouse 
b. son or daughter 
c. a step-son or step-daughter 
d. a parent or step-parent 
e. a parent of a spouse 
f. a grandparent 
g. a grandchild 
h. a brother or sister, or 
i. a spouse of a person referred to in paragraph (b) to (h) 

2.    Services are not benefits of MSP if a medical practitioner provides them to a member of the same household as the medical practitioner. 

Physicians should also be aware that billing for services to a family member is in contravention of the CMA Code of Ethics, which states: “Limit treatment of yourself or members of your immediate family to minor or emergency services and only when another physician is not readily available; there should be no fee for such treatment.” Furthermore, physicians whose family billings exceed $1000 are now being reported to the College of Physicians and Surgeons of British Columbia.

Billing for family members raises an ethical flag, which can lead to increased attention from the Billing Integrity Program—something most doctors would like to avoid. 
—Lorne Verhulst, MD
Chair, Patterns of Practice Committee

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This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board. For further information contact Juanita Grant, manager, audit and billing, Physician and External Affairs, at 604 638-2829 or jgrant@doctorsofbc.ca.

Lorne Verhulst, MD. Audit red flag: Treating a family member or yourself, and billing for it. BCMJ, Vol. 60, No. 3, April, 2018, Page(s) 174 - Billing Tips.



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