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Payment for Services

Federal programs and most state and private third-party payers will not pay for any service performed by a student or a physician in a training program. Payment can be expected if a student or resident performs the activity under the direct supervision of a licensed physician. If a medical student dictates a history and physical on a patient who is being admitted to the hospital and the attending physician cosigns this dictation after doing a history and physical, the physician may bill for the service. A physician who cosigns the dictation without doing the work is not entitled to payment for a service he or she did not perform. The physician also may violate the terms of his or her hospital privileges or the laws on delegation of medical authority.

It is particularly important that consent and billing for surgical procedures be done appropriately. If a resident is going to be performing a surgical procedure, the patient must be aware of this and the attending surgeon must be scrubbed into the surgery and directly supervise the entire procedure. It is not good enough to be available if needed. In the first case, the attending surgeon is arguably doing the surgery through the resident. In the second case, he or she is simply trying to collect a fee for services not rendered. If the patient has signed a consent for the attending surgeon to do the surgery, the absent surgeon is also perpetrating a fraud.

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