And Why You Cannot Afford to Get This Wrong

I’ve been fired by clients.
I’ve been yelled at.
I’ve been blasted online in front of thousands of people.

And every single time, it’s been about one thing: fraudulent billing. Not because I was doing it, but because I was the one educating people on it.

So if you’re reading this and feeling a little tight in the chest… this post is for you.

“But We’ve Always Done It That Way...”

Here’s the situation I see over and over again: A new associate joins the practice. Their credentialing is still in progress. Someone, maybe a colleague, maybe your owning doctor, tells the office it’s fine to just bill under a credentialed provider’s NPI until the new doc is fully credentialed.

“It’s just temporary.”
“Everyone does it.”
“We’re not trying to commit fraud, we’re just trying to get paid.”

I hear you.
But here’s the truth: Intent doesn’t matter when you get audited.

Let’s Talk About Sonrava Health

If you think your office is too small to be on the DOJ’s radar, think again.

Earlier this year, the Department of Justice announced a settlement with Sonrava Health. Their offense? Billing under the NPIs of credentialed providers for services actually performed by non-credentialed ones, and it cost them $540,000 in settlements and restitution.

And no, that’s not even the worst-case scenario. In other cases, people have been arrested. Licenses have been revoked. Reputations shattered.

This is real. And it’s happening right now.

Here’s What You Need to Know

You cannot bill under another provider’s NPI unless they performed the service: Even if the associate is in-network. Even if they’re “almost credentialed.” Even if you’re just doing it “for a week.”

Billing under the wrong provider can trigger False Claims Act violations: Yes, even if you eventually get the associate credentialed. Yes, even if you think the payor “won’t care.”

Credentialing delays do not justify billing fraud:  You have other options, like delaying treatment when appropriate, providing temporary limited services, or working with your payors directly. But billing under the wrong name? That’s not one of them.

Why I’m Sharing This

Because I don’t want any of my clients, or anyone in this profession, to learn this the hard way.

I know what it feels like to be stuck in survival mode, to rely on "what someone once said," and to feel like you’re too busy to worry about details like this. But this is exactly the kind of detail that can shut down your practice.

This post isn’t to scare you. It’s to protect you.

So Here’s My Offer

If you're unsure whether your billing practices are compliant, or if you just need someone to double-check what you've been told, let's talk.

I’ll help you spot red flags before they become front-page headlines.
I’ll give it to you straight (but with a lot of heart).
And I’ll always come with the receipts.

Don't wait until the DOJ is knocking. Because I’d rather lose a client for telling the truth, than stay silent while your license is on the line.