Q: I have been working in a group private practice as an independent contractor for past year. Because of numerous problems with the management, I am considering leaving and starting my own practice. I have a question that I can’t find the answer to…
I recently discovered that checks from one of the insurance companies with which I am credentialed has been sending my checks to the office where I work, made out to me, and only me, not me@practice name. Apparently, the management has been intercepting these checks and either cashing them or depositing them in the business’ account. Then, they have been writing me checks for (ALLEGEDLY) the percentage we agreed to in my contract, but they haven’t been providing the EOB’s for reference. Is ANY of this legal?
A: Dear Concerned Counselor,
I am sorry to hear that things are not working out with the group practice, where you are currently practicing.
About the matter with your checks, here is what’s probably going on. Even though the checks are coming in addressed to you, and you only, and you you@practice name, it is likely that the insurance company is still paying the practice’s tax ID number, not your social security number. This basically means, the practice will receive a 1099 at the end of the year for those monies, not you (i.e., they are paying the taxes on that money). Hence, as long as they are paying you your agreed share, everything should be kosher financially speaking. And legal.
About the EOBs, this was probably not an issue earlier in your relationship with the group practice–as you trusted they were paying you accurately. My guess is that as your relationship has deteriorated, you’ve become less trusting. I do think it’s reasonable to ask to see a copy of the EOBs. Alternatively, you might be able to call the insurance company and inquire as to what they have paid out. Or Thirdly, you could look at the insurance company’s reimbursement rates, and then do the math to determine if you have been getting a fair split (this last one will just be approximate, but at least you’ll know if your checks are within a reasonable range).
I hope this helps!
Anthony Centore Ph.D.
And your friends at Thriveworks