Medicare officials do acknowledge that Medicare could appropriately be billed for services provided by a PA when the physician did not see the patient. Medicare does pay specifically for services provided by a nonphysician during a minimal office visit with an established patient, even when a physician isn't present. However, officials in the Office of Coverage and Eligibility Policy have noted that the types of services thus covered by Medicare depend on the patient's history, the prior involvement of the physician and the level of services provided. None of this is spelled out in detail in the Medicare rules. In many physician offices, support professionals assume much more responsibility for the treatment of patients.
Many PAs have their own substantial patient loads.
At times, patients are not even aware that they are being treated by a nonphysician. I have heard of situations where a single physician supervises more than a dozen PAs, each with his or her own patient load. PAs have provided inpatient care far beyond what is specifically permitted for inpatients by Medicare, with these services then being billed by the physicians as if they had personally provided them. But the danger is there, and it is substantial. The government certainly may argue that these are false claims.