On the face of it, appears reasonable. In reality, it stinks. Violates all sorts of rights to privacy, "innocent until proven guilty", and that sort of constitutional stuff.
The patient would be a government employee spending approved government money so doubt you could sue .... what about all the real patients who lie to get things they want?
Look..............all you have to do is look at the individual numbers of payouts to physicians from these programs....................kinda like those chiropractors who billed several millions a year...........it does not take a genius to know that you cannot crack that many backs in a year to bill that much.................but, to violate the sanctity of the exam room, putting each of us in jeopardy, well, I just do not buy it. Now, if they will do that with members of congress, the judiciary and the legal profession, then OK, I will buy in. But, such endeavors will capture only a few true thieves while many will be labeled thieves and lives destroyed over some misunderstanding of some bureaucratic mumbo jumbo.................remember, the ones stealing the most are also the ones giving the most to the politicians, judges, and lawyers and thus will never feel the pain of justice.
entrapment. It doesn't stand in criminal law. We are being managed outside of the Constitutional legal system.
As I sit here in the hospital on rounds mostly working for free this Sunday AM,
I still say, pick a week any week. No medicare patients that week. Or heck close the office for a week. But everyone HAS to do it. Either act or quit your bitchin'.
Medical fraud is small as compared to total health care spending but it is important to root it out. There are many ways to find it and correct it. But sending undercover agents to physicians office or hospitals will spoil the trust between health care professionals and patients and their families. Won't know who's who in your practice. I am against medical fraud. This should be investigated properly and punished appropriately.
Just another great reason to stop seeing any government insurance. Think about this, you have just been cut in payments to the point where almost all of us cannot take medicare and keep our head above water. Now they want to play gottcha! Right now if you forget to document one bullet, you get downcoded from a 5 or 4 down to a three. They don't care if you spent 45minutes with them you get paid for 15. What about an extended visit. You spend 65 minutes with them. You can only be reimbursed for 40 because to use the extended visit codes it has to be a minium of an additional 30 minutes or 70 minutes. They are coming up with different ways to screw you.
If Medicare does this, all the other payers will start doing it, too.
They already have real Medicare patients who are empowered to look at their EOB's and their friends' EOB's and report discrepancies between what was billed and what was done. One of my patients did that in her retirement community, and that was 10 years ago. They were real patients getting real care from doctors of their choosing. The difference with Sen. Coburn's plan is probably that Medicare will choose the doctors to be targeted.
I don't mind undercover patients, although it seems illegal to me. Let's face it, even our most loyal patients represent a liability hand grenade so one has to constantly be thorough and careful--and most of us would be that way by nature and training anyway. My only request would be that the undercover patients estimate what the OV code would be and if Medicare sees we are billing for 99213 visits, but doing 99214 ones that they would extrapolate this finding to all our OVs (just like they would extrapolate and downcode all OVs if the undercover patients reported we were overcharging).
Most of the docs I know undercode their visits due to fear of being hassled by Medicare.
This is such a good idea that I would recommend undercover workers in congressional offices, law firms, auto repair shops, newsroom, etc. I once saw a lawyer whose desk was littered with files. He was a "friend" (not my patient) and told me he was billing eight clients $100/hr at that moment as he had all eight files on his desk. Now this was 25 yrs ago so $100/hr was a fairly high rate. I fired the lawyer of course. He eventually died of complications of an infected diabetic foot and, although he only took his insulin when he felt like it, I would imagine his death would have been counted among the "hundreds of thousands" dead due to hospital and doctor caused infections and poor treatment!
Add to part of your questionnaire, are you or have you ever worked as an agent, informant, or officer of the federal, state or local government or any agency affiliated with the same. If so, please elaborate. May attach additional sheets if needed. I'm not sure but if ask up front, I believe they must confess. It is best to have it in writing. Thus the defense is, if they lied on the intake questionnaire, how do you know they are not lying now, when they testify against you.
Whether it is a good idea or not. It is a breach of the doctor-patient relationship. Not only does the patient need to trust their doctor. The doctor needs to trust the patient that they are there for medical guidance and treatment with no ulterior motives.
I agree with Sermo Doc 11 that it would be nice if undercover mystery patients detected our under-billing and increased our payments, but this is not going to happen.
Mystery patients may detect fraud, but they won't detect much of it because they would usually raise red flags and put even the most unscrupulous doctors on guard against them. What they would do is damage the doctor-patient relationship and destroy the trust essential to maintain that relationship.
In 1982 such undercover patients infiltrated my office. I was running for the Columbus School Board at the time after the Board had in one year closed our Central High School and more than 60 public schools, most of which were in the inner city. Such school closings had made desegregation a one-way street going from the inner city in the morning to the suburbs and the other way at night. It placed the entire burden of busing on those who could least afford it and had two effects. First, it created massive white flight and promoted the real estate interests of the developing suburbs. Second, it devastated the inner city and made it into the decaying educational wasteland it is today.
After I, pro se, filed five lawsuits against the School Board and included hundreds of families in the Bottoms in these actions, the "other side" took action and fire-bombed my house, set my car on fire, slashed my tires, cut my brakes, tapped my phone, and infiltrated my office. Mystery patients suddenly appeared, and they stuck out like penguins in the jungle. I wondered what brought them into my neighborhood. They didn't look, talk, or act like inner city people. One planted hidden microphones that my dog detected and chewed up. None kept a return appointment or left a valid telephone number.
Though they discovered little about me, they damaged my relationship with my patients. I had no choice but to assume every patient was "undercover" and took extra precautions. Just as today we treat every patient as if he or she were HIV positive, then I treated each one as a spy. At first, I was hesitant to accept new patients I did not know or who were not referred by existing patients. Eventually I played games with the phone lines I knew were tapped.
This was 1982, two years before the year 1984 that George Orwell foresaw in 1948. We don't need Big Brother in our offices today any more than I needed him in 1982.
No other professionals, not lawyers, not politicians, not bankers would allow such intrusion into their private lives. We shouldn't either.
I like Dr. Coburn, but I think he is very naive to think that the government would not use this opportunity just to screw good physicians as well as bad and villianize the entire profession.
I would not trust the government and their motives.
PE: Gen: A & O x 3 HEENT: PERRLA, EOMI, O/P -clr Neck: supple, no LAD CV: RRR , no M/G/R Pulm: CTAB Abd: soft, NT, BS+ Extr: No C/C/E
Think how much "fraud" these undercover patients will find on physicals exams that are documented like this but were really not performed as documented.
This was the guy pretending to be our friend. "We have met the enemy and he is one of us.
The people billing millions go unnoticed, but he wants to go after the ones doing the work [at a huge discount ]
The problem is degree. I believe the rules are so complex we all commit somw violation every day, we just don't know it. You know, forget a bullet. Forget to document the need for the UA. You could even argue in a BMP why did you get the Na? Why not the other electrolytes, etc. I worry about the abuse incentive. If they could limit themselves to real fraud, I would agree. Dr. Coburn may have been on congress too long to realize the rule changes.
That's still small potatoes compared to the nyumber of filthy physicians bilking billions out of medicare (so we are told by the Washington crwod on both sides of the isles). I agreee with Sermo Doc 19 though, should go after the ones's that are openly plundering the system and catch the users (medicare fart) that initiates the illegal attempt at procuring medical equipment at the taxpayors expense.
I guess I'm lucky that I'm a gaspasser....by the time they get to me, they are going to get surgery. I doubt fake patients are willing to go that far;-)
i'm not big on the idea of doing surveillance on random people -- if you have probable cause to think someone is willfully defrauding medicare, then yeah, that's understandable
by the way, what about all the medicare fraud by patients who have fake disabilities (I know, some doc helped get them certified but their assessment was based on info given by a lying pt)
I can see pros and cons to this in concept. My assistant was seen by a local doc and was charged for a 99215. She was very upset when she got the bill, because she is savvy enough to know that she did not get a full "99215-worthy" exam. But, it's her word against the doc's, because exam findings were documented. She ended up paying it. And changing primary care docs.
That said, it does seem that the government casts a wide net and makes few discriminations, like between innocent errors and fraudulent intent.
As far as mystery patients go, you may have already had a few. I know of attorneys in my area that will schedule an appointment and be seen, either for legitimate issues or fake ones, just to check out a doc before hiring them or sending clients to them. I've had it happen to me.
They want to go "undercover" and prosecute us for fraud if we bill a dollar for something we did but did not document, but they do nothing to prosecute Caresource for paying its CEO 2.9 millions dollars that should have gone to medical care and hiding it from the IRS.
This is not unlike incarcerating a poor grandmother in The Bottoms of Columbus for stealing a chicken to feed her starving children but giving a $595,000.00 bonus to the bankers who stole billions from our country and put it on the brink of bankruptcy.
If Senators Coburn and Schumer think something is a good idea, look out! Here's a better idea. How about if they hire me as a "fake constituent". Actually I'm a real constituent but I could never donate enough cash to get a visit with a Senator. So let me meet with one of those scumbags, offering $50,000 in exchange for promised support of pending legislation. How's that sound fellas? Fraud is so damn easy to find. Give me one hour with CMS and SS and I can tell them how to shut down at least a few hundred million dollars' worth. And I'll do it for free.
Not to be a buzzkill, but did anyone realize that you just received a 40-50% reduction in salary overnight? Undercover patients are the least of your problems.
Trying to figure out how to survive should be where you focus your fingertip energy.
Sounds like a good idea on the surface,but knowing how the government handles things now,I can envision many good physicians going broke defending themselves for hiring just one poor coder;how many of you double check every code that leaves your office?
I asked my wife to be an undercover patient in my own office to test how the office staff handled her issues. I intentionally told my wife to be "difficult". Good way to see how your office staff is. Different concept altogether however, if the government was involved.
Dr. Coburn was trying a little too hard to come up with something he and the Dems could say "we agree" on. I think it's a cynical idea and as such it would be just one more tool used to divide doctors. Divide and conquer, that's the plan. It's even worse than the audits to check our level of coding, so that most of us undercode and get under-reimbursed (and Iearned here on Sermo that even undercoding is fraud!). Changing the MD after my name to MAD!
This is just silly. It sounds like they plan on creating another government department filled with bureaucracy and likely its own waste and incompetence. I guess they would have a "red flag" system and just not arbitrarily select providers. However, most of us don't have a lot of time for the patients we have and to add in someone who doesn't even require real medical care is a waste of resources.
Would the president be willing to allow undercover physicians to pose as politicians or even CMSS personnel to decide whether any fraud or intent to defraud on the part of Congress or the Dept. of Health and Human Services? To put it another way, has politifact done any research or do they have any "estimates" to throw out regarding the cost that physicians suffer on an annual basis when it comes to lost revenue for undercoding, Medicare cross over billing errors, rejections that need to be resubmitted for no reason other than "system glitches" and then, delays due to fiscal issues or as is the case now someone's capricious decision to withhold payment for the first 10-14 days to "see" if Congress wishes to act on something which they have ignored for well over a decade. I ask you. Does any of this balance against the $13 billion they claim is being fraudulently claimed requiring espionage tactics which will invoke unnecessary costs on physicians parts in generating paperwork and manhours for fraudulent patients.
The concept of reeling in fraud is admirable and needs to be done; on that point we are fully agreed. But like waterboarding there is an unethical and distasteful feeling about the proposed methodology that just doesn't seem appropriate under the apparent facade of a democratic, free, and just society.
At the very least I would hope that this sort of behavior would have to be approved through the chambers of Congress before being implemented...unless of course, the president chooses to use executive power in declaring this an issue of national security.
Perhaps, it would please the government if we were to refer all new patients for either neuropsychological testing, polygraph tests, or MMPI's as a matter of giving them the most comprehensive examination possible to weed out these imposters. Or just have them get a shot of amital first before filling out any paperwork or talking to anybody at the front desk. That would be less costly.
Coburn's plan seems like it is going to target PCPs. I doubt that is where the fraud is. They are already so underpaid that in my area it is next to impossible for a patient on Medicare to find a PCP. Only those employed by hospitals take Medicare and they have little incentive to pad their billings, as the hospital knows they are loss leaders anyhow. In order to get to a specialist, they first have to do a fake PCP visit. I think most of the fraud is through expensive wheelchairs that are "sold" to fake Medicare patients and the like.
I wonder what they will do when this shows that the amount of actual medicare fraud is very very small. Perhaps they can investigate the investigators. There must be a conspiracy someplace! (There is. Its the government pretending there's all this fraud.. Lets investigate them)
If these informants are willing to endure a rectal examination and a cystoscopy, they can come to my office and get what they deserve! I wonder if forgetting to use jelly or lidocaine counts as "fraud?".
The real problem, is that these contractors will be paid only when they find "fraud" in your office. So, expect them to have bullet-proof authority to brand you a crook, take a couple hundred grand out of your hide (which they will split with Uncle Sam). There will be no appeal, there will be no way to clear your name.
This is just another excuse to get more fingers in your wallet.
You should always act defensively . Even without the government, you could still get a reporter or investigative journalist as "undercover" Several years ago a colleague of mine got massacred in an "expose" for prescribing and dispensing contact lenses to a new "patient" without doing a full eye exam. I still get the sweats when I remember the article
It figures that Obama would like THIS (and only this) proposal from a Republican. Because this would legalize spying on law abiding citizens, a feature of any socialist or statist's agenda, Obama and his band of thugs would be in favor of it. Now I can see the headline " Obama embraces bipartisan agenda; accepts propopsal from Republicans"...ignore the tort reform, free-market practices of insurance competition accross state lines, etc...jump right to the "jack-boots -on- your -doorstep" proposal...When will America wake up and realize that this "health care reform" is ALL about control, and nothing else?
I'd love to see who's gonna sign up to be an undercover patient for the colorectal practices, or the OB/GYNs, or the urologists. Hard to imagine the patient who wants to undergo a digital rectal exam a dozen times a day, five days a week. Then again, maybe there are some.
All Medicare needs to do is randomly audit charts and compare to charges submitted. They have done this twice in our office (Pulmonary/Critical/Sleep) and attempted to down code for services, but we appealed (some time consumption required) and won. Since then, we have not heard from them again.
At a time when salaries are falling and pressures rising, the last thing we need is a law enforcement strategy that fosters mistrust between doctors and patients. It's hard to relax and focus on the patient's concerns while also worrying about whether the patient is an investigator. I don't object to undercover investigations tipped-off by analysis of billing patterns because there are doctors who are padding their wallets by up-coding and other reimbursement enhancing schemes. There are ways to enforce the law without intimidating law-abiding physicians.
Hopefully, this intrusive trial balloon was just a bi-partisan bargaining ploy. Dr. Coburn is very intelligent and doesn't usually trust the "heavy foot of government" to do anything efficiently.
If this intrusive strategy is ever implemented, I would hope he, or one of the other physicians in Congress, will ensure that the undercover patients are assigned to the offices of the 20 percent of U.S. physicians who have more than two career malpractice settlements (a surprising number have more than ten) in combination with one or more licensure actions INSTEAD OF the 80 percent (about 800,000) who have two or less (many with none) in their careers.
EMR's lead to fraud on a daily basis because they document things that weren't done or said. And who's pushing EMR's? The feds!
I don't fear undercover patients cause I take my time, document what's said and done, don't push into things I'm not qualified to do, and don't cut corners on insurance. Most of us can say that.
Having worked for the feds in several realms over the years, you can be sure such a program would be filled with such bureaucratic incompetence that the u/c patients would be wearing neon! Look at the Air Marshals program. Those guys stick like a third eye.
Finally, just catching bad docs means nothing. You still have to have the wherewithal to prosecute and convict, and there's no certainty that the feds could do that. Bad docs get away with things all the time. Just look at the blocks upon blocks of " oxy-shops" in Broward County and the toatal silence of the feds on that issue.
The problem will come with defining what is standard of care. Medicine is an art. I routinely discover problems patients have that were never diagnosed before. With an undercover "brother" physcian what will he or she make of that? Oh that doctor did uncessary exam and testing, I dont have glaucoma since no one diagnosed me with that before? Slippery slope
What happened when the Madoff whistleblower alerted the SEC to Madoff's fraudulent scheme years ago?? Nothing!
Undercover patients are a friggin waste of time and our taxes...go after the real 97% fraud out there. Docs are easy targets, the true crooks are well protected and have the money to fight any investigation!
what a crock. We don't have enough money to pay more than pennies on the dollar for those already enrolled in Medicare, and we're going to waste more money on NON-patients. Coburn ought to know better, then again, maybe that's why he got OUT of medicine and went to the dark side of politics. We're already looking at 80+% of those of us who responded to a poll today who are going to either stop seeing new or stop seeing ALL medicare patients, and these idiots think we've got enough free time to see fake patients. What a joke.
I'm not opposed to the idea - Medicare surely needs to do something about fraud, but I think it would be better to see them start with DME and then expand the prgram (or not) depending on what they get there.
At the same time, I sure as hell don't support the idea. It simply smacks too strongly of the East German Staasi in the 1980's, when 1 in every 3 East German citizens was enrolled in programs for spying on their fellow citizens.
I guess if the gubmint's gonna do it, they're gonna do it. I sure would like to see them find a better alternative, though.
Are doctors offices equal to Bloomigdales and Applebees where there are mystery shoppers and diners? I thought having a professional degree would command a bit more respect.
Talk about Pandora's box! Will it be like the RACS where the Gov't employee will only make a percentage of the fraud they find? Who will decide what is clearly erroneous billing? you can see how the margins are grey and will totally expand over time. Many of us would just go to cash only.
TAKE MY PEN!!! So, they worry about incorrect charges, poor quality of care, but won;t let me write the meds I want, nor order the tests the patient needs. Are they willing to accept the responsibilities we do for patients' lives? Why would anyone want to be a physician? Hopefully the young remain idealisitc, or who will take are of us as we become seniors?
I had an undercover cop try to get a prescription for opiates by feigning a back injury. He came in with a fake Medicaid card and a drivers license with a phony address. His medical history could have been used to write the "Doc-Shoppers Manual" and it looked like he spent extra time studying Waddell's signs. He got a prescription for some aspirin and an X-ray request on his first visit. He came back for his second visit with his X-rays and I remarked that it would be understandable for someone with arthritis to this extent to have significant pain. I also remarked that he must have had an incredible surgeon to be able to do a spinal fusion without leaving a scar. At this point, I told the officer to "have a nice day," but I no longer had time for his antics.
My suspicion is that Medicare fraud could be rather easily screened for, by using statistical analysis of existing data. I have NEVER knowingly committed Medicare/Medicaid fraud, or any other type of fraud for that matter. My understanding of M/M fraud is that most of it is found in the medical equipment business or done by organized crime, not primary care doctors. Law enforcement would be wise to focus their efforts there.
Looks like I need to add a question to the entry questionaire each patient must fill out annually. "Are you now or have you ever been a paid or undercover informant to the government at any level?" If they answer falsely then entrapment is my defence. What a country!!
Like putting a cop in your car to find out if you are breaking the speed limit.
Gummit already has the data --- it suffers data overload, doesn't know what to do with it and is afraid to enforce current laws/regulations for fear of being politically incorrect, stepping on toes and reducing political donations, etc.
We should insist that from now on, all colonoscopies are done without sedation so the snitches / patients can make sure that you actually reached the cecum.
I'm not sure I believe Coburn's statistics. There is probably more waste than deliberate fraud. There is probably more cost in the way medicine is practiced that is accepted as standard of care or "business as usual" that doesn't really help patients. You may call it futile care. You don't need an undercover patient to see it. Just take a walk through any ICU and you will find it everywhere.
This 'idea' is just another example of government intervention in the best gun control and DUI check point tradition.
Gun control keeps guns out of law abiding citizens hands, not criminals, and DUI check points inconveniences the many, to catch the few. This measure will increase costs and the real crooks will just figure another way to work the system. Perhaps, if Medicare had 'real world' fee schedules, there would be fewer who turn to robbery. But hey, the Medicare system has been ripping off docs for decades, that's why I don't partake.
Many years ago I had a string of DEA agents try to get steroid prescriptions from me, and each one got the 'just say no' speech. Another well spent piece of government expense.
I never have been impressed with Medicare's attitude towards physician especially after I signed my first Medicare "physician attestation statement". I felt like Richard Nixon when he stated "I am not a crook". I have been fond of the concept that physicians are presumed to be not guilty until proven otherwise. I suspect that most of us know that Medicare fraud is real but resent having to spend time and effort to prove that we are not part of it every time we deal with Medicare. My solution would be for Medicare to focus its attention on the egregious offenders. I suspect that after some of them are publicly arrested, convicted and sentenced to be "Bubba's girlfriend" (assuming they are male) for at least 20 years you might see fraud rates go down. Unfortunately as is true with many enforcement agencies it is a lot easier for Medicare to go after the legitimate doc who didn't fully understand the rules and made a mistake than pursue the real criminal. It makes me love my government..........
No objections to that. Fraud needs to be dealt with in a way that does not punish good doctors. Also we should police ourselves and report fraud when we see it.
My first question to all my patients would then be, "Do you work for any enforement agency investigating fraud and abuse". If they lie, then they are at risk for entrappment an all the ensues that ensue. Being a physician, is not like selling drugs and using DEA like tactics....or is it?? Orwellian I suppose....
The solution to inappropriate or futile care is ==> make the family pay every penny that medicare does not pay. See how quickly they'd agree that the care is futile! But as it is right now, this is not allowed. When patients or families control the money the decisions start to make a lot more sense. Those of us who treat small business owners who are self-insured or the out-of-pocket payers know that these pts, unlike the others, are cost-savy.
Since I work in another county, I go "undercover" every year when I go to the county health department for my annual exam. The NP was the most thorough general medical professional I have ever come across. This is COUNTY medical clinic!
I agree with the person who said this idea looks good on its face, but not so much when viewed up close--the whole concept of the "snitch" or "mole" is always repugnant, from grade school on.
Imagine our resumes/CV 's. We would all be perfect for the undercover patient job. And we would all qualify for government perks and benefits to boot! We will undoubtedly save the government millions. Especially since none of us will be accepting Medicare .
It is acceptable only when the criteria for fraud is specified. Otherwise one can always create a history which necessitates multiple diferential dx or treatments which may have multiple treatment choices. Since much of medicine is in the art, it is easy to trap someone for not making the "correct" judgment based on the pubications Medicare may choose.
I think the entire idea stinks. Yes, let's go clog up a system that is already understaffed and flooded with needless paperwork and now we are to start taking care of bogus patients. I don't think so! Obama just needs to have everyone dress in brown shirts and the cycle will be complete.
Great idea on the face hard to see how you do it in actuality unless the "mystery patients" all have real disease, otherwise its entrapment. Otherwise how would you order tests on a patient with no physical findings?
All I can imagine is a national rerun of that Seinfeld episode where Kramer and Mickey fight over who gets "cirrhosis" and who gets "gonorrhea" to "act" for the med students . . .
I would probably get gonorrhea in my practice, thinking extra urethral swabs and mutliple rectal exams in order for the "mystery patients" - sounds like something the Unions, Acorn, or Volunteer America would be all over.
I thought that this was already happening and was for many years, but for doctors they were suspicious of. One of the reasons I quit Medicare was not wanting the Feds coming to my office with guns asking for my charts. Haven't you guys read about such things. And not only do they take the chart of the patient in question, but they can take your other charts.
The idea attacks only part of the fraud problem, that is doctors who chose to commit fraudulent acts. But the bottom-line is that "undercover patients" are not the solution, it will give a patina of effort but frankly the large "fraud machines" are co-operative efforts between providers and their clients.
Will these mystery patients pay for the first office visit up front. or will I be seeing them for 3o minutes and get paid nothing. If they want they could always find something to ding us with. NIMO not in my office is my answer.
I wouldn't diss this idea too fast or too roughly. A very legitimate complaint from the public and from the government is that we do a lousy job of policing ourselves. If we become the "insular peer group of NO outside inspectors" it will not play well. In particular it may impact the public's willingness to accept tort reform.
Why are we so afraid of RAC audits and shill patients? Because we believe that we can never win against them. The rules are irrational and uninterpretable. No reasonable human is ever involved in the process. I propose that this is chimerical fear and that most of us would survive a shill patient just fine.
As an example, in my previous stomping ground there was a notorious heart group which had a prominent first floor location in a nice pavilion. Patients looking for the GI clinic upstairs would often stop off to ask where it was. On one well-documented occasion the patient never made it to GI, but left s/p angiogram EKG echocardiogram and treadmill which is just what you do to evaluate burning epigastric pain.
How about uncovered doctors who have the gall to confront drug seeking scamming patients? Do we get bonuses for "whistleblowing" on the fraud and abuse committed by these "patients"?
When I was a shoe salesman, the idea of "professional/fake" shoppers coming in, paid for by the company that gave me a pep talk q3mo to get me to sell more accessories to get those commisions, who took my time away from legitimate (paying, not returning for refund) customers, rubbed me very wrong. As a shoe salesman my customer service skills were being evaluated.
The idea of a fake patient to evaluate my integrity as a physician (paid for by the government) rubs me even "WRONGER". Problems include all of the above, as stated by so many of you. In addition, the process is intrinsically flawed -- shoppers had real feet which fit real shoes. What do you do w/ a patient feigning a complaint but w/ no evidence of pathology? Or w/ real pathology & a real doc but is coming in pretending not to? Finally, Sermo Doc 52 hits the real nail on the head -- this would mushroom into a new bulbous bureaucracy w/ all the incompetence, cost-overruns, and inefficiency of pretty much all other bulbous bureaucracies.
Isn't medicare "fraud" something as simple as doing, say, an 11-pt neurological exam vs a 12-point and clicking "WNL" on an electronic medical record and moving on? Doesn't that constitute "fraud?" Most of us are trying to treat patients appropriately and comprehensively, then fill in the boxes just so to capture what we did. A far better idea would be to see how many of us undercode purposely so as not to commit "fraud." Why not send undercover agents in to ferret out all the bills that need to be coded UP?
We are living in difficult times with a President who emulates some prior unsavory politicians. What we are now witnessing is just the beginning and will grow in scope unless stopped in its tracts. I am retired now several years and apoligize to the current generation of physicians for allowing this to happen. Thirty years ago I tried to sound an alarm about the growing politization of medicine. It was not heard and there were many in my generation who chose to play with the system which has now turned on all. This was done it seems by virtue of guile amongst unsophisticated physicians prone to enjoy noteriety. In the future I hope there will be a healthy level of skepticism among physicians
This came from Coburn??? A physician, ostensibly???
Isn't that what the teabaggers are up in arms against, this apparent intrusion of the government into all our lives? I mean, leaving out the incoherence of their position, aren't we supposed to be against this sort of warrentless searching and witch-hunting? Are we ACORN?
If the Republicans can suggest crap like this with a straight face, I can only wonder why anyone likes them, much less the progressives and the social libertarians. Given the choice, I prefer the Dems; they at least honestly disrespect us
This is completely wrong!!
In my 4 years as a medical student and 4 years as a resident and several years in practice I have never seen false billing, and I have followed well over a hundred Doctors. This whole notion of fraud and abuse is a façade. What the general public thinks when they hear of "fraud and abuse" is fictitious billing by physicians for services that were never performed. What in reality the Fed is after is counting all of the bullet points in the SOAP note to see if they add up to the level of coding. What will really happen is Doctors will get axed by the government as the informant counts off the number of bullet points that were addressed during the visit and if the physician falls just one point short of the level of coding they will be hung out to dry as a criminal.
Please, all of you Doctors come to your senses. We have seen this profession disintegrated one piece at a time. Each piece that is taken away doesn't seem to hurt but over the years there is nothing left. We have no one to blame but ourselves for letting this happen. Come to your senses and oppose this at all costs. If we don't, we will be even more paranoid. We now have to worry about getting sued, in some states about the medical board (think TX), About the DEA if your Rx any narcotics, about the Medicare RAC (especially for those of you who are ready to retire, just picture a RAC audit 4 years in to retirement and you lose your nest egg), and now some of you think it is a great idea to start each patient encounter paranoid that it is a federal agent ready to bust you. Believe me these undercover patients will be outsourced and their income and bonus will reflect how many Doctors they can bust and thus they will have an incentive to trip you up during the exam.
Please come to your senses and say enough is enough!!
Completely bogus, boogie man approached that will be botched royally. Coburn is a stupid (or very shrewd politician) who proposed something that is very inane. It only reinforces the "doctor blame game"; it adds nothing to how broken our healthcare "system" is. It does reinforce the chaos embedded in the minds of politicians about how to problem-solve. The politicians (Coburn especially) should be focusing on how to get the middleman out of the way of the doctor-patient interaction, not add to that burden. But come to think of it, this is yet another shrewd way to destroy Medicare.
Now that the 20% Medicare cut is in force, I'm hearing from some of the docs most in demand in my community. They are considering pulling out of Medicare now. This will be just another reason to drop Medicare. GO AHEAD, MAKE MY DAY..... I don't think there is enough conviction good will and unity to fix the current system. The faster
it falls down, the sooner we can build another system!
This is another loser government idea. Shame on our supposed peer Tom Coburn for coming up with this one. As most of the above comments reflect, there is abundant room for fraud and abuse in using this tactic. Very bad idea. Big brother BO in the office. Yikes! Isn't it bad enough that you can get RAC-ed with the government breaking down your doors with guns drawn? This truly is 1984.
Agree with Sermo Doc 6, there is plenty of Medicare and Medicaid fraud, but looking at volumes and numbers billed with a subsequent audit makes more sense.
Medicare/Medicaid fraud is a crime, just like any other. You use undercover cops to look for fraud in many other industries, why would we be exempt? The Gov. does have a responsibility to go after fraudulent claims just as much as private insurers.
Now if there was only a way I could report patients that are gaming the system - Medicaid patients with new iPhones, gold jewelry, fur coats, new Nike's at every visit, and drive home in a Cadillac.
They don't need undercover patients when the fraud is so blatant. There are many many cases of patients reporting fraudulent use of their Medicare numbers and CMS did absolutely nothing after multiple complaints, sometimes over years.
They should investigate all the reports of fraud that have been pushed to the back of the file and do a little basic computer work: Look for anomolies such as new companies that bill huge amounts, sudden increases in billing for particular types of things (DME, home health, etc) or variations from regional norms ( to catch the crooks who export their skills to new markets). The fraud comes from professional criminals who set up shop and exploit Medicare, not from doctors who see patients and bill for "piece work."
CMS has been so negligent in pursuing real fraud that finding or creating a few more cases with secret patients won't help one bit. All they might do is entrap a few doctors who make foolish decisions when enticed by a potential quick buck. They are not the problem.
I think the real fraud is in the DME folks and what about all the home health? You should see the reimbursement! Every time I sign one of those authorizations I have to wonder what the bill is and were they seen? Just have to be curious. We all know the scooter scams!
Honesty, driven by fear! Wow, what does this say about the state of affairs?
How about we also put undercover pages in the senate?!! And in the Whitehouse?!!
Hey, attorney's offices must also have some undercover folks...as after all, we are truly interested in "the truth" aren't we?
Ridiculous. Coburn's lost his sense of direction ...and his will to stand for privacy, personal integrity, liberty, smaller government without intrusion, etc....
I'm not a fan of this undercover approach and am, quite frankly, surprised others are.... Maybe this is the sign of a major social paradigm shift toward the acceptance of big brother watching, Yikes!
This is a GREAT IDEA! It will create jobs. Of course, you know the cost-per-visit of the investigator will be higher than the amount paid to the doc for the services. But since that's being efficiently reduced by the gummint, it might work out well for all concerned. And no, we won't request an equivalent investigatory process for our elected officials, 'cause we know they are LICENSED TO STEAL.
If we want to get after fraud, we'd best come up with some legislation that monitors HOSPITAL BILLING!!!
I just returned from Haiti with my biceps torn free from the proximal radius....and the 45 minute "simple fix".....so far....without the physician's component or the MRI.....is $13,000.
The itemized bill I requested contains some of the most opportunistic highway robbery that I've ever laid eyes on.
The pharmacy bills $168.00 for every single 2 ml vial opened...of any substance....such that the total lot of meds used in the 45 minute procedure cost $1300....and the real cost is about $100. Bupivicaine = 5 ml = $168.00! Zofran = 4 mg = $168.00! Toradol 30mg IM = $165.00! Ancef 1 gram IV = $265.00! No administration costs included, as they were separate.
AND this was ONLY the tip of the iceberg. Four surgical "packs" weighed in at a total of over $8,000!!! Now, we are talking merely about a single easiliy isolated, freshly torn tendon....replanted on the radius with a simple button screw. That's it! 45 minutes of what the surgeon called "a very easy fix". I can't wait to add the surgeons bill and the MRI!!!
Throw away BP cuff = $865.00.... Etc.....
This system is screwed up! We need hospital / insurance billing reform....where there'a more open accountability ...and much more COMPETITION.
Your orthopedic surgeon's charge will be in the 500-600 dollar ballpark which I think is an underpayment for such level of training. You are right. Hospital bills=highway robbery. I took on our local hospital and decided to start my own office based endoscopy in 2006.. Within 6 months the hospital dropped the endo-suite fee from $2800 dollars to $500 for self pay patients. In my office I do a self pay patient for much less including my professional component. The hospital has since gone on to buy local practices of primary care docs. When an insured patient goes there they tag a facility fee for visits! The insurance companies keep paying all these inflated charges. Their only focus is their bottom line. SO long as the money is flowing in from people and their executives go home with fat salaries they don't care. . Forbes had an article about this : www.forbes.com I suggest you contact WSJ or David Whelan of Forbes
I am going to open a lobotomy and ECT clinic and invite all the undercover congressmen/women that want to come by...wait, that assumes they have higher cortical capacity which is doubtful at best...
Does anyone really think that this is a new idea? The insurance companies do it routinely. I have a family member who works in the fraud division of the local Blue Cross office, and when she started, her first job for a number of years was to go undercover to sniff out insurance fraud and inappropriate billing practices of local docs. I was appalled.
Sermo Doc 90: Some years back I had a new pt. called a week in advance for back pain. This is always a redflag. How does he know he will have back pain in a week?As a former cop, I used the time to research the pharmacies. With this guy, he had 7 pages of single-spaced opiate activity. At the visit, he denied seeing any other docs or receiving any prescriptions. While I was with him, my manager checked his name and address, and found them both to be false. Since he signed a record request with his intake sheet we got records for 7 Er visits., most of which he used medicaid as payment. She checked those addresses and phone numbers, and they were all false.
The patient left after being confronted, sans script, and I called the state regarding his medicaid fraud. They thanked me profusely, and promptly denied payment for the visit. One month later, I was in our ER and happened to see his chart, waiting to be seen for "sarcoma" of the back, still on medicaid.
So, it doesn't matter how well you make the case, or how clearly fraudulent, there is NO will to confront fraud. I think it makes a great sound bite, so they all spout it, but the system is so huge and unwieldy, that the developmentally disabled people who people federal agencies, have no idea how to Just think of the mind dead robots who work the counter at your post office trying to undertake this effort.
Sounds to me like a paranoia-spawned piece of Republican propaganda, meant to incite outrage and fear among the ranks against the current government; you know, sort of like "death panels".
As I understand it, most of the Medicare fraud comes from billing services/ procedures on patients that were never seen by the "billing" physician anyway, so sending in an undercover patient to doctor's offices won't pick up much fraud.
So this undercover patient will take up valuable office time, AND the doctor won't get paid for their time since they isn't a legit claim that can be placed? That doesn't seem right.
Sounds to me like a paranoia-spawned piece of Republican propaganda, meant to incite outrage and fear among the ranks against the current government; you know, sort of like "death panels". ' Sermo Doc 107 -
I heard him on TV at that conference say that they should send in undercover patients.
Here from a transcript is what he said: near the end of his comments
In your new bill, you have good fraud programs, but you lack the biggest thing to do. The biggest thing on fraud is to have undercover patients so that people know we're checking on whether or not this is a legitimate bill. And you don't know who's an undercover patient and who's not, and all of a sudden you start changing your attitude of whether or not you're going to milk Medicare or you're going to milk Medicaid.
Just so we are clear, Senator Coburn did say this...I watched him say it and was dumbfounded!
On the topic of Medicare waste, fraud and abuse...
Fraud is the blatant billing of Medicare, often by non-physicians who have set up shop and stolen physician identifiers to flood the system with false claims. This has been done in Miami by illegal immigrants. Few physicians have been involved.
Waste is what occurs in a gigantic government bureaucracy and could be reduced by simplifying the system. But you don't hear the politicians discussing this openly.
Abuse is what occurs in physician offices when they do something like intentional up-coding a visit. This is what CMS is using the RAC audits to discover. In 2007, according to their own data, less that 0.3% of lost revenue could be accounted for by "abuse". This is inconsequential in the larger picture.
But, when politicians talk of waste, fraud and abuse, the public thinks that the greedy doctors are ripping off the system. Simply untrue in most cases.
OK I get to vent on fraud. Having been an expert medical witness in two medical fraud cases against chiropractic ripoff artists in California of Workers Comp cases, I can tell you that we MD.s are amateurs at gaming the system. Billing $18,000 for a series of 3 Manipulations under Anesthesia, using sedative drugs which is prohibited in California for Chiropractors (they Hired MD anesthesiologists for the sedation) and did 3 day series of manipulations, using neurosurgeon codes of cervical, thoracic, and lumbar vertebral manipulations to generate huge billings to Workers Comp, at outpat. facilities unaccreditated/unlicensed, and billed facility fees of $7 million. The patients were non english speaking day laborers who had coverage under workmans comp, so started with 60 visits to the office, then referral to collegues, then pain med services (kickbacks) then Manip. Under Anesth. None ever were proven to get better, back to work, etc. But they got great lawyers (Horowitz) and gamed the system to the end. Confused lay juries(Fresno) and walked. The fraud in Medicare is the mobile medical clinics, run by Russian mafia, in LA getting Mcare #a or MCal # and billing for tests never done. Millions scammed, none recovered. Anytime a system of payment is set up, crooks will figure out how to game the system
the problem with this idea is the word of the agent against the honest health care provider, and then the case ending up in the court, where the prosecurors and judges have already decided the health care worker as guilty and thus conduct and monitor the trial before the jury, supress the exhonerating evidence and then directing the jury to find the honest healthcare provider as guilty, or worse yet not giving the trial to the healthcare provider and violating the constituonal right of the defendant and forcing the defendant to plead guilty to misdemeanor in front of the non-judge working as judge.
this is the atrocity of the justice system, and should be condoned, by the healthcare provider community.
If the "patient" has good insurance and I get paid, bring them on. Like all drug seekers, they'll get a no nonsense approach from me, and leave the practice once they figure out I don't take any B.S. Let's see them generate old medical records. I agree with many of the other issues mentioned above. One downside is the mental drain dealing with such patients who make your day that much harder, and detract from caring for real patients.
Sending fake patients to physicians' offices who write a lot of narcs seems prudent. While they're at it, will the govt send people to spy on my patients to monitor compliance with my instructions so that I don't get penalized with "pay-for-performance" when patients are noncompliant?
The mere fact that some of us are actually justifying this approach is the real problem. This is yet another vice placed around our genitals to shackle us and control what we think, do, say, and bill. Lets be realsitic, does anyone feel that an undercover audit would ever be fair or reliable?
If any one of our charts was combed over, there are bound to be 1 "mistake" or as it will be called "fraud" in ROS or PE, or time spent etc. None of this, by the vast majority is intentional or meant as a billings bonanza. Yet it will be treated as such and you will be crucified.
This is yet another last straw that should break your back before it really does break you.
No other profession or group endures this type of micromanagement, bullying, regulation, or price fixing. People need to wake up and define what really matters and how far you are willing to jump and through how many hoops before enough really becomes enough.
No Sermo Doc 113, they won't spy on your non compliant patients yet, but you might have missed their rectal exam. It should be done every visit and improper diet and weight gain is clearly associated with malignancy, which could occur at any time.
Don't forget a complete and very thorough (to the splenic flexure) exam.
As the surgeons say "it's not complete unless both the patient and physician are sweating".
I have definitely seen many cases of billing fraud...my patients used to come to be with outrageous stories of unbelievable charges/coding for MD's doing nothing...
But DME and scooter fraud has got to add up to much more than anything we do. I do not mind fake patients being sent to docs with unbelievable billing records...
However, the records will usually speak for themselves, and a billing/scheduling audit is all that is really needed...
If the gov pays these faux patients money depending on how much "fraud" they detect, however, it will be the end of most of us accepting medicare!!
I hope they send one in for an EMG. I wonder how long it will take me to stick every muscle in the body? I haven't done the tongue in a while. The anal sphincter aught to be fun too!
What a shame , what had medical profession come to. I am being policed by the most corrupt of all , politicians wait that is lawyers, wait they are both the same.
How about me policing all the kickbacks these guys are getting from device makers , drug industry lobbyist. Yeah billions of dollars to save their but they will cut my 21% , social medicine is around the corner.
We need an urgent Psych consult for Sen Coburn
How are these fake patients going to get an appointment if we stop seeing new Medicare patients due to the reimbursement cuts ?
Today our group told several would be new Medicare patients we would not see them until the reimbursement cuts are sorted out and gave them our local Congressman's phone number to call.
I think every time we are falsely accused or investigated or reprimanded, is one step closer to all of us refusing to deal with Medicare and Insurance Monopolies. Send in the spies!
Can they be "shot" as spies? That might limit the number of shill patients. I can see it now. If someone flunks out of TSA training, they will send them to patient spy school. It will cost hundreds of millions and maybe send some docs to prison. Unfortunately, they will be doing hard time for clerical errors or misinterpretation of rules that the supreme court could not unravel.
I continue to believe that most of us in this profession put our heart and soul into what we do, with the intention of helping others. This type of element in the physician patient relationship can erode trust and is a poor strategy that could hurt those with only the best of intentions.
I can see the prison yard now. Scruffy looking gray haired guy, "What are 'ya in for?"
Me, "I was convicted of medicare fraud".
Scruffy, "how did they do that?"
Me, "I saw a patient, who was really a medicare spy, did a thorough exam and forgot to mark a box". "They eventually down coded it from a 99214 to a 213, a $20 dollar difference in charges but only 67 cents in take home." "I got 20 years at hard labor".
Me, "who is that guy mumbling to himself in the corner?"
Scruffy, "That's crazy Jack, he's in for tearing the tags off of his mattress" "He scoffed at the label warning, under penalty of federal law." "You better stay away from him for a while!" " They sent his cell mate, Butcher Bill home on early parole to make room for you."
Me, "What did Butcher Bill do?
Scruffy, "He killed and ate his whole family." "They put him in the federal pen because he cooked them in trans-fat, which was prohibited in his state."
Me, "What did you do?"
Scruffy, "I got caught with a roach and didn't have my script for medical marijuana." "I got 99 years."
I agree w/ retirell, Also look at the fraud that is built into the system. Example: I took care of a guy on medicare after becoming "disabled" from a herniated disc. He is 42 years old and ALREADY milking the system. Let me assure you, this man was completely capable to get up out of bed and go to work. Let's cure that. (By the way, the patient told me he wasn't on disability any more. "No, I'm on medicare, " he told me. Great huh?)
The legal question is whether this becomes "enticement" or a "sting" operation. The DEA is known to do this kind of thing when investigating "drug mills." I dont know if the patient/agent is purposely supposed to state a reason for the request that does not appear reasonable. Most of the prosecution that I have read about focus on the doctor's prescribing with minimal to almost no history and no physical examination. As the patient/agent is willing to undergo whatever the doctor considers normal at the time, it is not considered enticement.
The idea of "secret shopper" patients has been around for some time - as a marketing/quality gimmick. It has been argued against as limiting availability for real patients. (And, when used as a "quality" measure, there is the relationship that is built up that is important. Is there any artifice in the nature of the "patients?" Having never experienced a "simulated patient" first hand, I do not know if they have the actual malady or are merely actors told to feign the complaint.)
THIS IS A BAD IDEA- TRUST ME ON THIS ONE. I HAVE SUFFERED THROUGH THIS .
Based on a suspicion and a complaint about a namesake physician in the same building- I had 2 patient visit me-
AGENT A- FAKE NAME AND DOB, GOVT ISSSUED ID, CHECK UP DONE, LEAVES OFFICE- TOLD TO LOSE WEIGHT, LOWER CHOLESTEROL - TOTAL 248, LDL 147 AND FOLLOW UP IN 3-4 MINTHS FOR FASTING LABS.
AGENT B- " MY CHEST IS HURTING" EKG DONE AND TOLD TO SEE CARDIOLOGIST WHO TOLD him TO GET A STRESS TEST AND ECHO- RISK FACTOR WINK WINK- FAMILY HISTORY OF CAD AND HE HAS ANGINA
What happenned after that should put the fear of GOD in you- The investigative OIG agent wrote a report saying , while no fraudulant billing was done - they had diagnosis which were not present!!! these guys had seen another physician prior and were told what to do and that they are healthy. So I guess I should have ignored the facts and history given!!
I had to look for an attorney and spend tons to save my reputation till they dropped everything. Guess what- now I see no patients who do not give me their drivers licence , Matching insurence, NO patients with PO boxes, one valid emergency contact, one cell number( VAlid) .
This is going to destroy physicians. They come prejudged and assume facts and report. They want things to fit into what they are looking for- You cannot sue them either!
How do you spell his name is it Coburn or COCKburn! Oh yea is his first name Richard? I mean DICK! It's a great way to guarantee that thousands of physicians will no longer see Medicare patients me included.
Yet again is an example as to why I say it's not one party or another it's both parties that are the problem.
We need to take our constitutional right to the voting booth and fire the lot of them and hire some new ones! Think about it folks, if we actually did that, it would actually turn the entire political system upside down!!!!!!! Start in Nov 2010 and finish the job Nov 2012.
If these guys are Govt. agents undercover, shouldn't they be required to show their proper ID before seeing any Doctor? What about Miranda Rights, a lawyer present, probable cause (Bill of Rights, Amendment IV)...???
Aren't these agents conducting illegal "searches" without probable cause and denying innocent Doctors their rights?
I am hearing much complaining (rightly, so). But as long as you keep participating, and accepting their ludicrous fee schedule..... the doctors deserve to be abused. Just say hell no, and get out of Medicare. I did it years ago, and my practice flourished. Instead of chasing the government for the pennys on the dollar they were throwing me (when they actually paid), I chose to get out and get paid commensurate with my skill and work.
Agree that the $15K scooters (made in CHina or Mexico for slave labor wages no doubt) and the twice the price rx meds are much more eggregious and abusive than anything I could ever do in my office. And the anti-trust exemption for the Anthems of the country.
Medicare paid $37.14 on Friday for a level 3 OV. Today they will "allow" $30. Oh, and the 5 page form that the doctor is supposed to fill out for the $15K scooter? Zero.
I have practiced in a setting with "secret patients". It actually worked well. It raises the staff's attention to detail a little, especially when you know they're coming sometime that week. Also, reminds you to be more HIPPAA compliant, friendly, etc.
I have witnessed plenty of medicaid fraud - my sister called to ask the home health agency to come out after the nurse had canceled her weekly visit. The agency said that the nurse had already billed and filed notes for a visit that never happened. After investigation, they were able to document dozens of fraudulent home health visits this nurse had billed for.
The truth is, fraud happens. Knowing someone is holding you to a standard improves the quality of your performance. Get involved to make sure that if they put this in the bill that the "punishment fits the crime."
This is all well and good and very Democratic in form. Has anybody considered checking up on Medicare/Medicaid recipients to see if they continue to qualify for benefits? It often makes me consider quitting all work and going on Medicare myself, when I have to deal with the person in the ED toting the Gucci bag, talking on the iPhone while twirling the BMW(Mercedes, etc. you can fill in the proper make) key fob and demanding a prescription for Tylenol for their child just in case he gets sick on the flight home to the Dominican Republic to visit.
This idea of spying on doctors made by this politician and colleague it just proves how determined our representatives are to get into our lives,to control us and to devaluate the respect of the people for our profession. Dr. Coburn probably does not need to practice medicine anymore and to be paid a mediocre fee. In the other hand if his idea gets implemented this would be a good push for many of us to finally consider to get out of Medicare. If they want to crack down on Fraud they can be very successful if the investigate offices and clinics that suddenly start billing for multiple services that are not generally on the scope of the doctors' specialty or that grossly deviate from the usual billing patterns of the doctor.
Sermo Doc 134, good idea:
"checking up on Medicare/Medicaid recipients to see if they continue to qualify for benefits?"
Also, consider checking the deceased whose relatives/friends/nursing homes are still receiving benefits from Medcaid, Medcare, and Soc. Security as well.
I quit medicare 10 years ago because of the Draconian punishments a doctor received for "Medicare Fraud" in which an internest coded wrong (according to the AMA & Medicare). No way was I going to have Uncle looking over my shoulder. I follow the guidelines of my specialty group and am picked as a best doctor year after year. The greatest danger to this country and the reason for it's decline is the Federal Government. Now they want to "regulate medicine" Not on my watch! If only we all had the strength to say NO! Quit Medicare. Quit Medicaid. Tell them to stuff their public option and practice good medicine.
SLAVERY still present : after working so many years of hard work exams , night calls and exams again . some stupid is going to come to your office and destroy you if you are off from their mark.
Fraud is a very complicated subject. Fraud might be found by looking at how many patients a doctor saw during each hour of the day (some kind of signing in technique)and deciding if this meets the recommended time for a visit. The electronic record helps, but one must be sure the doctor did not write essentially the same note for each patient. I have heard of doctors that will dictate a chief complaint and a plan and summary and have the typists add by cut and paste the same Physical exam and Review of systems for every patient. When a patient has an Echo the echo tech fills out a form that can be typed directly, if the physician trusts his echo tech implicitly, maybe he does not have to look at the echo at all, or the holter, or the nuclear Scan- this certainly saves time. And I knew of doctors who did there own echos in less than 5 minutes, is this fraud? One such doctor is a multimillionaire, how I wonder. Some people say that all important tests should be done in the hospital, but can you really trust the greasy CEO with his political job in a 12 piece suit? Then there are institutions that oversee quality, and charge a great deal of money for their certification. Are they really overseeing quality or just making sure doctor's money makes it to the bank. I dont think they do anything for quality, but they could be required to do so! The desire to do fraud is not inhibited when the government bails out a bank and they give their CEO's multimillion dollar bonuses from US taxpayers money, for driving their bank in the ground!!! The doctors still remember how the Clinton's made the economy better by developing the HMO system which practically ruined medicine immediately. I remember it was said that the HMO's were supposed to suppoirt research- guess what- they only support their CEO's 12 houses and prostitutes galore!!
Why don't we just have the government hire a Secret Service Police force, with one "officer" assigned to each physician. He can then follow the doc around, ticketing him for everything the SSP thinks the doc does wrong, or if he orders a test the SSP doesn't feel is necessary, or if the doc uses a brand name drug, or.....
You get the picture. The more the government becomes involved in medical care, the less of a physician/provider to patient relationship will exist, the more lawsuits will occur, and the fewer good physicians we will have (who would want to work in that environment?).
Sen Coburn is a doc in name only, and represents us about as well as the AMA.
I just wrote to Dr. Coburn .. to ask him what he was thinking? I support the guy with money too. So I dont get it? Well it must be some sort of radiation that is present in the capital building that turns docs into politicians that dont remember the trenches. I have also supported Dr. Steve Kagan a Dem but honest guy at the start. He has turned to the dark side too... lol
One of the deans of my alma mater was spotted acting as an undercover patient , after hours at one of the university`s surgical clinic. Nothing came out of it, other that is did not improve Prof Antoni`s reputation.
It is certainly a waste of resources.
In the bariatric realm there seems to be a little misinformation for patients. I used to perform open roux-en-y gastric bypasses at a smaller hospital and really held the patients accountable for proving preop lifestyle changes and excercise prior to even considering them for an operation.
I can tell you that I turned more patients away or refused to do their surgery because they could not make the commitment and excercise their end of the bargain i.e. personable responsibility for their health by making the changes.
Now i'm sure they just went on to find a "center of excellence" were they were more than happy to operate if the patient just jumped throuth the hoops and met criteria.
Down the road there was a small hospital that started doing lap bands and I was told by several patients that I had seen that didn't even qualify by BMI standards when they saw me, that when seen by the lap band surgeon they were accually told they had to gain "x" # of lbs to be considered for surgery and then to come back. One patient was told she had to gain 40 lbs. and did just so she could have the procedure because her original motivation was to loose 30 lbs.
So, surgeons telling people how to qualify for an operation that they are not a candidate for just so they will eventually be able to qualify for it.... I guess medicine has become a business and some physicians are willing to do irresponsible things to get more cases and boost income.
I'm not sure undercover patients is the answer but something shoud be done to ferret out these hacks who will do what they need to keep the steady flow of patients coming.
I think we should have undercover lawyers, congressmen, senators, and other numerous bureaucrats to catch these slimy bastards perpetrating acts of corruption on an hourly basis.
If they are really an undercover agent, are they also a "patient"? if not, then is there a doctor-patient relationship or is it a doctor-undercoveragent relationship; and if the latter, are the rules for coding different? If they lie in any manner, does this invalidate the entire visit/sting operation? A complete new patient evaluation should include a rectal exam. If they want a second opinion, then two fingers are better for that purpose.
Dr. Coburn's "idea" would be obviously illegal, let alone ineffective. Unfortunately, his paper-tiger tactic of distracting people from the real issue of health care financing is effective. Sermo Doc 60 is right. Look at all the anger described above, in response to an idea that should have been shrugged off from the start.
Too many top politicians on the Right have adopted this political tactic, making grandstanding inflammatory remarks in order to derail substantive debate. A US representative from Minnesota accused the Obama administration of causing the Swine Flu epidemic. A US Senator had his family build an igloo in the DC snow, to jeer at Al Gore's position on climate change. Another US senator remarked that it was "understandable ..." that a nut enraged about tax policy flew his plane into a building and killed other US citizens.
I'm really, really worried about where the US is headed, if we can't talk sense to each other.
They would have to be undercover. JCAHO sent a mock patient to our ER one time to play some type of quality survey game and I simply flat out refused to see them. We see 250 patients in an average day with only 3 doctors and 3 mid-levels and certainly plenty of LWOBS as it is.
I couldn't find an ICD-9 code for "government employee pretending to be a patient with ficticious complaint"."
Ridiculous, inappropriate, un-American, "Big Brother", and certainly unlike anything the legal or political world would advocate take place in their fields / professions....!
Let's advocate undercover pages in the senate!
Let's advocate undercover cabinet persons in the White House!!!
The notion of putting "undercover" patients in the clinical setting like this is just wrong.
How about they simply look over all hospital billing statements for 12 months? There's tons of excessive and "creative" misuse and abuse there.
How about they monitor simple things like when MAC anesthesia is used. In what medical situations is it truly appropriate and necessary? This is real example of an area of abuse,....that should be very easy to evaluate and cut back on,...with regard to its unnecessary use. It's used for a larger and larger % of simple diagnostic GI endoscopies....costing ~$500 and up per patient. It's being used for "office procedures" like EVLTs. Just at our rural hospital, where only three docs do endoscopies....it's costing our local community an extra ~ $250,000 per year.
Or, if this irritates some and reduces their "take home"....then relax the restrictions on its use and allow RN's to certify to give it.
Multiply this 'misuse expense' by hundreds of other hospitals in our state...most much larger than our 28 bed facility.....and you've got a great deal of excessive charging going on. AND this is but MERELY ONE example of MANY.
Medicine / medical insurance / malpractice --- needs real competition,....open insurance sales borders,....a direct seller/purchaser relationship between the insurance company and the insured, ......and meaningful tort reform. Why not simply start with these four? It wouldn't take more than 50 pages or so of legislation!!!
This is unbelievable. Are they going to do policing of doctors now? This is highly discouraging for people like me who are freshly coming out of residency. Whoever thinks that by doing these kind of stupid things, the cost of healthcare will improve should realize that it will be vice versa. This will badly alter the physician-patient relationship. In any case, we see tons of druggies and patients with fake pain and now on top of that we have to deal with undercover health detectives posing as patients. Whom should we trust in that case? The way health care is going on this country right now, the scenario is not very optimistic.
Instead of taking care of real issues, these dems and reps. are just busy in making their political careers secure. Why don't they bring the proper tort reform and stop the blood sucking lawyers from suing physicians frivolously? This will bring the cost of malpractice premiums down. When doctors get a sense of security, they won't order unnecessary tests to cover their back. Patients should also realize their responsibility and take care of their health as much as they can instead of solely relying on physicians to perform miracles. I mean, we are doctors, not car mechanics where you can bring your broken car and ask them to fix it without taking any responsibility. I just feel that no political party be it Dems or Reps. are interested in carrying out a proper health care reform which should and must include tort reform. They keep talking about how bad the health care is in States and talk big things but when it comes to doing something and make a change, they want to avoid all real issues and bring only cosmetic changes with these kind of stupidest ideas thrown in by someone who has an MD after his name. Disgusting..........
Sen. Coburn........you have disappointed us. In fact, let us down.
Nobody pinches someone elses pennies. The only way to successfully combat fraud and abuse and for that matter control costs is to put the money back in the hands of the consumer.
I think you could do this in the setting of investigating someone already under suspicion for specific crimes....just like duping a drug peddler into selling drugs to an undercover cop. But not indiscriminately. There is fraud. If we did a better job uncovering it, maybe some of the money saved would lessen the cuts the apply to physician compensation. With regard to the comment about Obama from Sermo Doc 84 - this was not his idea, but one proferred by a Republican.
this would be a wast of time in my office and most doctors offices.. CMS would need to reveiw suspicious claim histories to makea cas then investigate. Are they not already doing this. don't fsubject the vast majority of honest docs to more regulation,
The concept of a undercover patient is rediculous. What would the probability of finding a fraudulent doctor be?, unless the govt thinks the pretest probability of a fraudulent doctor is relatively high, and that is insulting. I have witnessed fraud. Certainly in Inpatient or outpatient cardiology a system could possibly be developed to detect it. You need an electronic record system developed by the government which auto-matically starts a clock when the doctor walks into the hospital or office (identity check from a wrist band or something). This electronic record would be on all the time and know when the doctor walks in and when he goes to the bathroom and when he is not seeing a patient. Then everything he does from seeing a patient to reading the echo, Holter and Nuclear study and seeing the patient should all be there. If the doctor sees a patient, writes a note, reads an Echo, Holter and Nuclear study ECG and reviews the lab tests and prior record of the patient in 5 minutes, and bills a medicare level 5 note, along with interpretation of all the data, something is very wrong. They can then gather the data from all the doctors and fraud may be evident. I unfortuneately can imagine this coming down the Pike, But doctor pay is a small portion of the total health care costs, so it sounds like they are focusing too much on the wrong fraction.
Anyway if you really want to lower health costs, close the medical schools and the Hospitals and all the clinics, Place a Priest and a Nurse in every pharmacy and the patient will have something prescribed by the nurse, get blessed by the Priest and go home. This will only work if the pharmaceutical companies do not raise the price of their meds by 10-fold, otherwise it might wind up costing more!. Oh Well.
Why don't we send in a mole to see what those SPOS's do all day and how they pi$$ away our taxes. As if we don't have to deal with governmental vermin enough. Now they'll be coming into our offices. And who the hell is Coburn? He's a doc? and a Republican? Either someone's stuffing his pockets or someone has pictures of him in a gimp outfit being spanked by a Cher impersonator named Kevin.
Wouldn't it be ironic if one of those sh1theads came in to waste our time and we found something incidental like a choroidal melanoma, a bruit, a breast mass... I wouldn't wish anything on anyone. Sadly in our political system something like this would have to happen for people to wake up and see that we're not so bad and as a whole we're not knowingly scamming anyone.
...even though that person is there under false pretenses and would love nothing more than to "nail us" I don't think a single person here would not do everything to treat or refer that person.
It goes like this. This is going on already in pilot states.
OK agent Bob. You are going to go into the doctors office. If you can come out and testify that the doctor checked a box that you don't think was accurate, we will fine that doctor 10 thousand dollars, and you get to keep half of that! Two boxes, double the money. Three boxes, triple the money! Agent Bob, you can make 15 thousand dollars in just one doctor visit!
I haven't read most of these comments - and I'm probably pretty much alone on this - BUT - if it paid REALLY well AND I got to nail some truly dastardly people, I'd sign up to do it.......you could trust me to do an honest and fair job.......I swear.....
I know a neurologist in a nearby city who does pain management and every new patient gets nerve conductions of all four limbs and echocardiogram regardless of their complaints. As far as EMG he always sticks just two hand muscles and that's it, I'm sure because that actually requires his time. This is not even close to the standard of care and not supported by the AANEM. How is Medicare missing this obvious fraud? It shouldn't take an undercover patient to figure this out.
we have had this system in the VA for a long time. I practice the way I always practice. I have no idea how many (or if any) of these patients I have seen. I think it is a waste of time and money, myself, but I have no control over it, and basically ignore it.
I agree that fraud needs to be eliminated, so good docs can be paid appropriately. This has implications for abuse, but would go a long way toward putting some of the medicaid mills, durable medical scams and pill factories out of business.
The ACORN pimp/prostitute video got thrown out on a technicality! Can you imagine the field day for politicians and the media frenzy this kind of stuff will bring about? This goes beyond 1984. Well, yes this was 26 years ago. We should be getting used to it by now!
Ok, fine. Are they going to have someone follow me all day and count the stuff I do for free, too? Yet another hit for primary care. Or were they going to have undercover surgical patients too?
To Kevin 972 and others: asking someone if they are undercover or police doesn't matter. Little known fact: Police/investigators can lie through their teeth and it is okay, you, however, can not lie to police. So asking them if they are investigators and they say "no' means nothing and doesn't protect you in the least.
It is amazing how so many of us are missing the meat of this topic:
It is a question of criminalizing the patient doctor encounter if it is not to the 'standard' of a government entity. So, everybody who is pro this policy should consider a real possibility:
Dr. Palenstrat has a political presence. Obama disagrees with Dr. Palenstrats' ideals and wants to make them disappear. He will then send off a herd of 'undercover patients' to 'objectively evaluate' Dr. Palenstrat's practice.
Behold, Dr. Palenstrat is not documenting nor asking clinically nonrelevant FH ancestry information on his patients which was clearly a necessity in order for the billing codes that Dr. Palenstrat is using. He did dis on all of his encounters! He had 100% noncompliance and was committing 100% billing fraud! Well, Dr. Palenstrat's license is very much at risk here, but lets hope that Dr. Palenstrat has a good attorney that will keep him out of prison!
Don't laugh, it could happen, and it could be you! Certainly, our medical political leadership would be at the greatest risk.
So, please do not agree with government Criminalizing Patient Doctor Encounter. It is bad for you, bad for patient and bad for democracy.
Sermo Doc 164. yes, physicians are especially vulnerable to harm by rumors and negative hearsay etc becuase a lot of our success depends on word of mouth marketing and reputation.
How about the fraud and abuse of making doctors fill out paperwork instead of spending their time taking care of real suffering.
My head spins with regulations. I think anyone in favor or more rules must have the new and improved Autism spectrum disorder. Such compulsiveness at the expense of reason is not justified. Perfect is the evil of good.
They would probably use the same folks who are after all the "fraud and abuse" and they would get a percentage of the "fraud" which they uncovered.
No thanks.
The crooks are the Insurance COs, the Medicare Mills, the Medical Equipment Suppliers and the Nursing Homes. That's where the Billions of fraud are occuring. Eliminate that fraud and the few greedy Docs will come around.
No one would argue that there are bad apples in all walks of life, we are no different. We could all name someone that probably this applies to, but I can name infinitely more that it does not.
It is not the prescence of poor docs, or defining them that bothers me. It is the means and violation that does. Lets be frank....Whatever the gov't starts something, it nevers stays that way, and eventually becomes bastardized into something uncontrollable, unfair, and prosecutorial.
I am a firm believer in the thought "what goes around comes around", so if there are abusers out there, judgement day will come. But the gov't should not assume the role of God/judge and jury etc....
In the midst of all of this healthcare talk, the gov't run postal service has just made the decision, that they will no longer delivery mail in Saturday. They can't afford to do this, as internet mails has robbed them of revenue. It is hard to believe that such a well run outfit as the USPS, can't weather internet technology. Why can't der Furor, fix that gov't run program?
Sermo Doc 114 - I hear ya.....personally, I've got nothing to hide and they can send bogus patients to me all day long and they'll all get the same treatment...I would resent the Hell out of it if I knew who they were but at the end of the day - I'd be found as squeaky clean as they come....if they hauled away some ne'er-do-wells in the bargain, that would be a good thing as far as I'm concerned.
Would I like being checked out? Nope, of course not........I guess that I might be a tad less sensitive to this than the next guy/gal....perhaps because I was in the military for ten years and Big Brother was sort of a way of life for me.......I don't know......if I had to vote on it, I'd definitely vote NO but if it going to happen no matter what, it would just be "business as usual" for me every day.
Don't get me wrong, I would DEFINITELY screw with them somehow if I figured out who they were...... ;)
Beware...It is rumored that if there is a five day Postal Service, Postal Carriers will be hired to be Undercover Agents on Saturday when you're rushing to see all your patients early and get out to the golf course! :-)
I must say, that there has to be some precedent or legal verbage that prohibits such blatant manipulation of a single practice/trade.
I would wonder how the AFL/CIO would respond to this type of "oversight" and quality "enhancement". It would seem to me that the unions big-wigs would be sweeter targets, but of course they are also the second biggest campaign contributors to the Congress/President.
is fraud because of greed- maybe or a way to pay for your office overhead and hopefully take some money home at the end of the day. if one has a majority of a practice consisting of medicare patients how does one make ends meet. if you need to cmmitt fraud to stay afloat then where does the problem lie- in the abysmal medicare payments? if one must use "fraud" to make ends meet then isn't it time to just refuse to accept medicare?
What you think this is a new idea? It's already happening and will continue to happen. Years ago I had a patient come to see me and wanting pain medication. He didn't have any pain. He said he wanted the meds because he was "psychologically addicted." As a surgeon I only prescribe pain meds for pain plus the patient's story was the most ridiculous thing I'd ever heard, I told the patient he needed psychiatric help for his psychologic additions and sent him on his way. Several months later I learned the DEA was sending agents to all the local physicians offices to "root out" illegal prescribers.
I've had others demand I bend the rules, take someone else's ID as theirs, write prescriptions in false names, bill for services I didn't perform. I always refuse. I am sure some of these "patients" were really government agents so as I said .... nothing new.
My response - just practice good medicine and don't fall for this crap.
Dr Coburn is an interesting guy- his practice found an interesting way to not exactly turn down Medicare and Medicaid, but to steer the great bulk of these low-pay/no-pay patients to the practices across town- they refuse to care for any OB/GYN patients if they smoke.
BTW, a lot of the the newly found billions in Medicare fraud has very little to do with criminal intent- it is from a going back and re-defining of "stuff we really shouldn't have paid for"..such as a procedure that had complete documentation of medical need and necessity, sending in practically the entire patient chart along with the bill, but one of the 16 signatures was now deemed illegible..or not dated and timed...
halliburton and blackwater (now called, mysteriously, "Z") spent more of our money in a day than Acorn has gotten in its existence....... don't hear about them as much around these parts, though
I do not like the idea of undercover patients. I think that I may have seen some undercover patients. I know that people would call in to our office asking question when they were really undercover looking to see if they had received the appropriate responses. I had seen patients whose diseases just did not make sense. Cancers tend to behave in a certain way as does multiple myeloma. Maybe I have just been in practice too long that I am seeing really unusual zebras like ocular recurrences, multiple myeloma disappearing, tracheal compression from a plasmacytoma, etc. I had wondered if some of these unusual patients might be undercover patients. If they were, that to me would be the absolute cruelest form of torture for a physician. As physicians, we agonize over every single decision that we make. When things do not make sense, we agonize even more. We worry that our fund of knowledge is inadequate. We worry that there is just that one article out there that solves the problem but that we could not find. Sending "mystery patients" to doctors to see if they violate any rules, to me as a dedicated physician, would be the absolute worst form of cruelty imaginable!
New patients, likely to be undercover agents, should undergo police background check for "office safety and security". This might weed out BO's agents.
I get patients and family members in once a week trying to get me to commit insurance fraud and medicare fraud. This is the kind of abuse that needs investigation and reporting. Whats good for the doctor is good for the patient.
Here in Massachusetts, undercover policemen can lie. So when I asked if he was a policemen he said no. If they have to say they are undercover agents when asked, then the playing field is leveled.
Sermo Doc 172,
It isnt about good medicine. If that were true, you would never have a medicare audit or be denied a claim. The vast majority of docs don't cheat the system, dont try to do so, nor do they fraud their patients or payors. Yet, most of us would not invite a medicare audit....why? Because we all know that undertrained, non-medical, henchmen will review your charts, and if 1 thing is out of place it = fraud. We are human like anyone else. Unless you document the same exam for every patient, you charting will change based on the sx/pt etc. You may not say or write something that you assume to be self evident....therefore it never happened and you never thought of it. You have to be a computer to remember ALL aspects of EVERY scenario, and none of us do that, we simply cannot.
Therefore, if rigged patients are intentionally sent, to audit our practices, and the threat [guilty or not] of gov't sanctions, fees, penalties, and most of all fraud attached to your name should raise concerns, particularly when it isn't true. And don't forget, you pay first, are assumed guilty....THEN you can appeal the decision. What other faction of business or private enterprise is guilty until proven innocent? You don't have to be guilty of anything to be charged or fined, you simply have to be human and we all are. How do you think RAC "recovered" 900 Billion in NY and TN in 1 year? Do you really believe that so much fraud/abuse had occured to equal that amount. It is also interesting, the no mention of what constituted that 900 Billion ever hit the presses. The only think printed was the dollar value, I would suspect there are heavy appeals in process, but nothing is or will be said of any reversals, that you can be sure of as it would be indicative of erroneous judgements by CMS and their hired/fee for service guns [RAC Auditors].
I am not paranoid, I am concerned of unfair characterizations that require time/money to reverse [if suspected], and cause irreparable damage to our names and character. It is not paranoia to suspect that there is a motive behind this kind of practice and where there is motive, there is money. Where there is money, there is the definite possibility of unscrupulous behavior. If I am not mistaken, one reason for the many Stark regulations is to deter such behavior amongst the greedy doctors/hospitals. If medicine is thought to be capable of such graft, would that not apply to RAC/undercover agents etc???
No one is arguing that is hasn't happened, and no one is asleep at the wheel either. The concern now is the scope, volume and pure motive behind the "upgrade" that will occur.
In the past there had to be firm concerns and "reason", that will no longer be the case. It will be a compulsory part of medicine, as a private business will be hired to specficically garner money, of which they get a piece. As it stands now, that "program" is federally run, with federal agents, and sparse. That would and will all change.
As long as physicians are considered innocent until PROVEN guilty, it MIGHT be alright. Historically however, this is not the way that administrative agencies approach physicians or anyone else.
I asked an undercover state policeman if he was a policeman and he said no. Any law should decry the ethics of denying what was apparent. His favorite movies were James Bond movies and in using a House Tree Person test his erasures gave him away. The police do type up the interview and leave out what is supportive of the doctor. Can you remember each interview with a patient?
The bottom line is don't take insurance and 90% of this type of problem disappears.
Shall we start with Dr. Coburn and place some microphones in his office, see how he likes it, then expand it to the other politicians to see how the little pilot study works?
If doctors got out of the third-party payer system, we would not be talking about this. When was the last time dentists, veterinarians, lawyers and plastic surgeons were humiliated like this? Wonder why? They take cash, no non-sense P4P, no QA, no phony overpayment for medically unnecessary services, no hiding behind "fraud and abuse" to save a bankrupt system.
it will create jobs too :-)
Qn is how many docs will be working with medicare?
The patient would be a government employee spending approved government money so doubt you could sue .... what about all the real patients who lie to get things they want?
As I sit here in the hospital on rounds mostly working for free this Sunday AM,
I still say, pick a week any week. No medicare patients that week. Or heck close the office for a week. But everyone HAS to do it. Either act or quit your bitchin'.
They already have real Medicare patients who are empowered to look at their EOB's and their friends' EOB's and report discrepancies between what was billed and what was done. One of my patients did that in her retirement community, and that was 10 years ago. They were real patients getting real care from doctors of their choosing. The difference with Sen. Coburn's plan is probably that Medicare will choose the doctors to be targeted.
Most of the docs I know undercode their visits due to fear of being hassled by Medicare.
This is such a good idea that I would recommend undercover workers in congressional offices, law firms, auto repair shops, newsroom, etc. I once saw a lawyer whose desk was littered with files. He was a "friend" (not my patient) and told me he was billing eight clients $100/hr at that moment as he had all eight files on his desk. Now this was 25 yrs ago so $100/hr was a fairly high rate. I fired the lawyer of course. He eventually died of complications of an infected diabetic foot and, although he only took his insulin when he felt like it, I would imagine his death would have been counted among the "hundreds of thousands" dead due to hospital and doctor caused infections and poor treatment!
Mystery patients may detect fraud, but they won't detect much of it because they would usually raise red flags and put even the most unscrupulous doctors on guard against them. What they would do is damage the doctor-patient relationship and destroy the trust essential to maintain that relationship.
In 1982 such undercover patients infiltrated my office. I was running for the Columbus School Board at the time after the Board had in one year closed our Central High School and more than 60 public schools, most of which were in the inner city. Such school closings had made desegregation a one-way street going from the inner city in the morning to the suburbs and the other way at night. It placed the entire burden of busing on those who could least afford it and had two effects. First, it created massive white flight and promoted the real estate interests of the developing suburbs. Second, it devastated the inner city and made it into the decaying educational wasteland it is today.
After I, pro se, filed five lawsuits against the School Board and included hundreds of families in the Bottoms in these actions, the "other side" took action and fire-bombed my house, set my car on fire, slashed my tires, cut my brakes, tapped my phone, and infiltrated my office. Mystery patients suddenly appeared, and they stuck out like penguins in the jungle. I wondered what brought them into my neighborhood. They didn't look, talk, or act like inner city people. One planted hidden microphones that my dog detected and chewed up. None kept a return appointment or left a valid telephone number.
Though they discovered little about me, they damaged my relationship with my patients. I had no choice but to assume every patient was "undercover" and took extra precautions. Just as today we treat every patient as if he or she were HIV positive, then I treated each one as a spy. At first, I was hesitant to accept new patients I did not know or who were not referred by existing patients. Eventually I played games with the phone lines I knew were tapped.
This was 1982, two years before the year 1984 that George Orwell foresaw in 1948. We don't need Big Brother in our offices today any more than I needed him in 1982.
No other professionals, not lawyers, not politicians, not bankers would allow such intrusion into their private lives. We shouldn't either.
video.google.com
video.google.com
trendsupdates.com
I would not trust the government and their motives.
Gen: A & O x 3
HEENT: PERRLA, EOMI, O/P -clr
Neck: supple, no LAD
CV: RRR , no M/G/R
Pulm: CTAB
Abd: soft, NT, BS+
Extr: No C/C/E
Think how much "fraud" these undercover patients will find on physicals exams that are documented like this but were really not performed as documented.
The people billing millions go unnoticed, but he wants to go after the ones doing the work [at a huge discount ]
by the way, what about all the medicare fraud by patients who have fake disabilities (I know, some doc helped get them certified but their assessment was based on info given by a lying pt)
That said, it does seem that the government casts a wide net and makes few discriminations, like between innocent errors and fraudulent intent.
As far as mystery patients go, you may have already had a few. I know of attorneys in my area that will schedule an appointment and be seen, either for legitimate issues or fake ones, just to check out a doc before hiring them or sending clients to them. I've had it happen to me.
This is not unlike incarcerating a poor grandmother in The Bottoms of Columbus for stealing a chicken to feed her starving children but giving a $595,000.00 bonus to the bankers who stole billions from our country and put it on the brink of bankruptcy.
Here's a better idea. How about if they hire me as a "fake constituent". Actually I'm a real constituent but I could never donate enough cash to get a visit with a Senator. So let me meet with one of those scumbags, offering $50,000 in exchange for promised support of pending legislation. How's that sound fellas? Fraud is so damn easy to find. Give me one hour with CMS and SS and I can tell them how to shut down at least a few hundred million dollars' worth. And I'll do it for free.
Trying to figure out how to survive should be where you focus your fingertip energy.
Look alive people. Your life is about to change.
can we send undercover folks to all of the crooked lawyers offices who cost this country billions if not trillions in frivolous lawsuits?
oh yeah, they have attorney client priv and run the country, silly me
NoDem- recent study out about how repeated CT scans cause a significant number of tumors per year
new ad
"Have you had more than one CT scan? diagnosed with a tumor? You may be entitled to compensation. Please the call the law offices of.....
The nightmare begins...add a few more Billions to the Budget.!
Government waste: $Trillions
The concept of reeling in fraud is admirable and needs to be done; on that point we are fully agreed. But like waterboarding there is an unethical and distasteful feeling about the proposed methodology that just doesn't seem appropriate under the apparent facade of a democratic, free, and just society.
At the very least I would hope that this sort of behavior would have to be approved through the chambers of Congress before being implemented...unless of course, the president chooses to use executive power in declaring this an issue of national security.
Perhaps, it would please the government if we were to refer all new patients for either neuropsychological testing, polygraph tests, or MMPI's as a matter of giving them the most comprehensive examination possible to weed out these imposters. Or just have them get a shot of amital first before filling out any paperwork or talking to anybody at the front desk. That would be less costly.
I am not comforted when one of my own medical colleagues suggests something as outlandish as this!
Shame on you, Dr. Coburn!!!
The real problem, is that these contractors will be paid only when they find "fraud" in your office. So, expect them to have bullet-proof authority to brand you a crook, take a couple hundred grand out of your hide (which they will split with Uncle Sam). There will be no appeal, there will be no way to clear your name.
This is just another excuse to get more fingers in your wallet.
PS: my wife is always 'difficult'!
Yeah, and I'm a chamealeon too!
They probably already have undercover patients too.
If this intrusive strategy is ever implemented, I would hope he, or one of the other physicians in Congress, will ensure that the undercover patients are assigned to the offices of the 20 percent of U.S. physicians who have more than two career malpractice settlements (a surprising number have more than ten) in combination with one or more licensure actions INSTEAD OF the 80 percent (about 800,000) who have two or less (many with none) in their careers.
See:
www.npdb-hipdb.hrsa.gov , and
www.npdb-hipdb.hrsa.gov
I don't fear undercover patients cause I take my time, document what's said and done, don't push into things I'm not qualified to do, and don't cut corners on insurance. Most of us can say that.
Having worked for the feds in several realms over the years, you can be sure such a program would be filled with such bureaucratic incompetence that the u/c patients would be wearing neon! Look at the Air Marshals program. Those guys stick like a third eye.
Finally, just catching bad docs means nothing. You still have to have the wherewithal to prosecute and convict, and there's no certainty that the feds could do that. Bad docs get away with things all the time. Just look at the blocks upon blocks of " oxy-shops" in Broward County and the toatal silence of the feds on that issue.
I bet they will not even reimburse us for those visits.
Undercover patients are a friggin waste of time and our taxes...go after the real 97% fraud out there. Docs are easy targets, the true crooks are well protected and have the money to fight any investigation!
At the same time, I sure as hell don't support the idea. It simply smacks too strongly of the East German Staasi in the 1980's, when 1 in every 3 East German citizens was enrolled in programs for spying on their fellow citizens.
I guess if the gubmint's gonna do it, they're gonna do it. I sure would like to see them find a better alternative, though.
When they "send in the Clowns".
Gummit already has the data --- it suffers data overload, doesn't know what to do with it and is afraid to enforce current laws/regulations for fear of being politically incorrect, stepping on toes and reducing political donations, etc.
www.msnbc.msn.com
Gun control keeps guns out of law abiding citizens hands, not criminals, and DUI check points inconveniences the many, to catch the few. This measure will increase costs and the real crooks will just figure another way to work the system. Perhaps, if Medicare had 'real world' fee schedules, there would be fewer who turn to robbery. But hey, the Medicare system has been ripping off docs for decades, that's why I don't partake.
Many years ago I had a string of DEA agents try to get steroid prescriptions from me, and each one got the 'just say no' speech. Another well spent piece of government expense.
All I can imagine is a national rerun of that Seinfeld episode where Kramer and Mickey fight over who gets "cirrhosis" and who gets "gonorrhea" to "act" for the med students . . .
I would probably get gonorrhea in my practice, thinking extra urethral swabs and mutliple rectal exams in order for the "mystery patients" - sounds like something the Unions, Acorn, or Volunteer America would be all over.
Why are we so afraid of RAC audits and shill patients? Because we believe that we can never win against them. The rules are irrational and uninterpretable. No reasonable human is ever involved in the process. I propose that this is chimerical fear and that most of us would survive a shill patient just fine.
As an example, in my previous stomping ground there was a notorious heart group which had a prominent first floor location in a nice pavilion. Patients looking for the GI clinic upstairs would often stop off to ask where it was. On one well-documented occasion the patient never made it to GI, but left s/p angiogram EKG echocardiogram and treadmill which is just what you do to evaluate burning epigastric pain.
The idea of a fake patient to evaluate my integrity as a physician (paid for by the government) rubs me even "WRONGER". Problems include all of the above, as stated by so many of you. In addition, the process is intrinsically flawed -- shoppers had real feet which fit real shoes. What do you do w/ a patient feigning a complaint but w/ no evidence of pathology? Or w/ real pathology & a real doc but is coming in pretending not to? Finally, Sermo Doc 52 hits the real nail on the head -- this would mushroom into a new bulbous bureaucracy w/ all the incompetence, cost-overruns, and inefficiency of pretty much all other bulbous bureaucracies.
Isn't that what the teabaggers are up in arms against, this apparent intrusion of the government into all our lives? I mean, leaving out the incoherence of their position, aren't we supposed to be against this sort of warrentless searching and witch-hunting? Are we ACORN?
If the Republicans can suggest crap like this with a straight face, I can only wonder why anyone likes them, much less the progressives and the social libertarians. Given the choice, I prefer the Dems; they at least honestly disrespect us
In my 4 years as a medical student and 4 years as a resident and several years in practice I have never seen false billing, and I have followed well over a hundred Doctors. This whole notion of fraud and abuse is a façade. What the general public thinks when they hear of "fraud and abuse" is fictitious billing by physicians for services that were never performed. What in reality the Fed is after is counting all of the bullet points in the SOAP note to see if they add up to the level of coding. What will really happen is Doctors will get axed by the government as the informant counts off the number of bullet points that were addressed during the visit and if the physician falls just one point short of the level of coding they will be hung out to dry as a criminal.
Please, all of you Doctors come to your senses. We have seen this profession disintegrated one piece at a time. Each piece that is taken away doesn't seem to hurt but over the years there is nothing left. We have no one to blame but ourselves for letting this happen. Come to your senses and oppose this at all costs. If we don't, we will be even more paranoid. We now have to worry about getting sued, in some states about the medical board (think TX), About the DEA if your Rx any narcotics, about the Medicare RAC (especially for those of you who are ready to retire, just picture a RAC audit 4 years in to retirement and you lose your nest egg), and now some of you think it is a great idea to start each patient encounter paranoid that it is a federal agent ready to bust you. Believe me these undercover patients will be outsourced and their income and bonus will reflect how many Doctors they can bust and thus they will have an incentive to trip you up during the exam.
Please come to your senses and say enough is enough!!
David Lancaster DO
it falls down, the sooner we can build another system!
Now if there was only a way I could report patients that are gaming the system - Medicaid patients with new iPhones, gold jewelry, fur coats, new Nike's at every visit, and drive home in a Cadillac.
They should investigate all the reports of fraud that have been pushed to the back of the file and do a little basic computer work: Look for anomolies such as new companies that bill huge amounts, sudden increases in billing for particular types of things (DME, home health, etc) or variations from regional norms ( to catch the crooks who export their skills to new markets). The fraud comes from professional criminals who set up shop and exploit Medicare, not from doctors who see patients and bill for "piece work."
CMS has been so negligent in pursuing real fraud that finding or creating a few more cases with secret patients won't help one bit. All they might do is entrap a few doctors who make foolish decisions when enticed by a potential quick buck. They are not the problem.
Honesty, driven by fear! Wow, what does this say about the state of affairs?
How about we also put undercover pages in the senate?!! And in the Whitehouse?!!
Hey, attorney's offices must also have some undercover folks...as after all, we are truly interested in "the truth" aren't we?
Ridiculous. Coburn's lost his sense of direction ...and his will to stand for privacy, personal integrity, liberty, smaller government without intrusion, etc....
I'm not a fan of this undercover approach and am, quite frankly, surprised others are.... Maybe this is the sign of a major social paradigm shift toward the acceptance of big brother watching, Yikes!
I just returned from Haiti with my biceps torn free from the proximal radius....and the 45 minute "simple fix".....so far....without the physician's component or the MRI.....is $13,000.
The itemized bill I requested contains some of the most opportunistic highway robbery that I've ever laid eyes on.
The pharmacy bills $168.00 for every single 2 ml vial opened...of any substance....such that the total lot of meds used in the 45 minute procedure cost $1300....and the real cost is about $100. Bupivicaine = 5 ml = $168.00! Zofran = 4 mg = $168.00! Toradol 30mg IM = $165.00! Ancef 1 gram IV = $265.00! No administration costs included, as they were separate.
AND this was ONLY the tip of the iceberg. Four surgical "packs" weighed in at a total of over $8,000!!! Now, we are talking merely about a single easiliy isolated, freshly torn tendon....replanted on the radius with a simple button screw. That's it! 45 minutes of what the surgeon called "a very easy fix". I can't wait to add the surgeons bill and the MRI!!!
Throw away BP cuff = $865.00.... Etc.....
This system is screwed up! We need hospital / insurance billing reform....where there'a more open accountability ...and much more COMPETITION.
www.forbes.com
I suggest you contact WSJ or David Whelan of Forbes
The patient left after being confronted, sans script, and I called the state regarding his medicaid fraud. They thanked me profusely, and promptly denied payment for the visit. One month later, I was in our ER and happened to see his chart, waiting to be seen for "sarcoma" of the back, still on medicaid.
So, it doesn't matter how well you make the case, or how clearly fraudulent, there is NO will to confront fraud. I think it makes a great sound bite, so they all spout it, but the system is so huge and unwieldy, that the developmentally disabled people who people federal agencies, have no idea how to Just think of the mind dead robots who work the counter at your post office trying to undertake this effort.
Sounds to me like a paranoia-spawned piece of Republican propaganda, meant to incite outrage and fear among the ranks against the current government; you know, sort of like "death panels".
Sounds to me like a paranoia-spawned piece of Republican propaganda, meant to incite outrage and fear among the ranks against the current government; you know, sort of like "death panels". ' Sermo Doc 107 -
I heard him on TV at that conference say that they should send in undercover patients.
Here from a transcript is what he said: near the end of his comments
In your new bill, you have good fraud programs, but you lack the biggest thing to do. The biggest thing on fraud is to have undercover patients so that people know we're checking on whether or not this is a legitimate bill. And you don't know who's an undercover patient and who's not, and all of a sudden you start changing your attitude of whether or not you're going to milk Medicare or you're going to milk Medicaid.
blog.newsok.com
On the topic of Medicare waste, fraud and abuse...
Fraud is the blatant billing of Medicare, often by non-physicians who have set up shop and stolen physician identifiers to flood the system with false claims. This has been done in Miami by illegal immigrants. Few physicians have been involved.
Waste is what occurs in a gigantic government bureaucracy and could be reduced by simplifying the system. But you don't hear the politicians discussing this openly.
Abuse is what occurs in physician offices when they do something like intentional up-coding a visit. This is what CMS is using the RAC audits to discover. In 2007, according to their own data, less that 0.3% of lost revenue could be accounted for by "abuse". This is inconsequential in the larger picture.
But, when politicians talk of waste, fraud and abuse, the public thinks that the greedy doctors are ripping off the system. Simply untrue in most cases.
Anytime a system of payment is set up, crooks will figure out how to game the system
this is the atrocity of the justice system, and should be condoned, by the healthcare provider community.
Sending fake patients to physicians' offices who write a lot of narcs seems prudent. While they're at it, will the govt send people to spy on my patients to monitor compliance with my instructions so that I don't get penalized with "pay-for-performance" when patients are noncompliant?
If any one of our charts was combed over, there are bound to be 1 "mistake" or as it will be called "fraud" in ROS or PE, or time spent etc. None of this, by the vast majority is intentional or meant as a billings bonanza. Yet it will be treated as such and you will be crucified.
This is yet another last straw that should break your back before it really does break you.
No other profession or group endures this type of micromanagement, bullying, regulation, or price fixing. People need to wake up and define what really matters and how far you are willing to jump and through how many hoops before enough really becomes enough.
Don't forget a complete and very thorough (to the splenic flexure) exam.
As the surgeons say "it's not complete unless both the patient and physician are sweating".
I have definitely seen many cases of billing fraud...my patients used
to come to be with outrageous stories of unbelievable charges/coding for
MD's doing nothing...
But DME and scooter fraud has got to add up to much more than anything we do.
I do not mind fake patients being sent to docs with unbelievable billing records...
However, the records will usually speak for themselves, and a billing/scheduling audit is all that is really needed...
If the gov pays these faux patients money depending on how much "fraud" they detect, however, it will be the end of most of us accepting medicare!!
How about me policing all the kickbacks these guys are getting from device makers , drug industry lobbyist. Yeah billions of dollars to save their but they will cut my 21% , social medicine is around the corner.
How are these fake patients going to get an appointment if we stop seeing new Medicare patients due to the reimbursement cuts ?
Today our group told several would be new Medicare patients we would not see them until the reimbursement cuts are sorted out and gave them our local Congressman's phone number to call.
Scruffy looking gray haired guy, "What are 'ya in for?"
Me, "I was convicted of medicare fraud".
Scruffy, "how did they do that?"
Me, "I saw a patient, who was really a medicare spy, did a thorough exam and forgot to mark a box". "They eventually down coded it from a 99214 to a 213, a $20 dollar difference in charges but only 67 cents in take home." "I got 20 years at hard labor".
Me, "who is that guy mumbling to himself in the corner?"
Scruffy, "That's crazy Jack, he's in for tearing the tags off of his mattress" "He scoffed at the label warning, under penalty of federal law." "You better stay away from him for a while!" " They sent his cell mate, Butcher Bill home on early parole to make room for you."
Me, "What did Butcher Bill do?
Scruffy, "He killed and ate his whole family." "They put him in the federal pen because he cooked them in trans-fat, which was prohibited in his state."
Me, "What did you do?"
Scruffy, "I got caught with a roach and didn't have my script for medical marijuana." "I got 99 years."
The idea of "secret shopper" patients has been around for some time - as a marketing/quality gimmick. It has been argued against as limiting availability for real patients. (And, when used as a "quality" measure, there is the relationship that is built up that is important. Is there any artifice in the nature of the "patients?" Having never experienced a "simulated patient" first hand, I do not know if they have the actual malady or are merely actors told to feign the complaint.)
Based on a suspicion and a complaint about a namesake physician in the same building- I had 2 patient visit me-
AGENT A- FAKE NAME AND DOB, GOVT ISSSUED ID, CHECK UP DONE, LEAVES OFFICE- TOLD TO LOSE WEIGHT, LOWER CHOLESTEROL - TOTAL 248, LDL 147 AND FOLLOW UP IN 3-4 MINTHS FOR FASTING LABS.
AGENT B- " MY CHEST IS HURTING" EKG DONE AND TOLD TO SEE CARDIOLOGIST WHO TOLD him TO GET A STRESS TEST AND ECHO- RISK FACTOR WINK WINK- FAMILY HISTORY OF CAD AND HE HAS ANGINA
What happenned after that should put the fear of GOD in you- The investigative OIG agent wrote a report saying , while no fraudulant billing was done - they had diagnosis which were not present!!! these guys had seen another physician prior and were told what to do and that they are healthy. So I guess I should have ignored the facts and history given!!
I had to look for an attorney and spend tons to save my reputation till they dropped everything. Guess what- now I see no patients who do not give me their drivers licence , Matching insurence, NO patients with PO boxes, one valid emergency contact, one cell number( VAlid) .
This is going to destroy physicians. They come prejudged and assume facts and report. They want things to fit into what they are looking for- You cannot sue them either!
Yet again is an example as to why I say it's not one party or another it's both parties that are the problem.
We need to take our constitutional right to the voting booth and fire the lot of them and hire some new ones! Think about it folks, if we actually did that, it would actually turn the entire political system upside down!!!!!!! Start in Nov 2010 and finish the job Nov 2012.
Aren't these agents conducting illegal "searches" without probable cause and denying innocent Doctors their rights?
Stop complaining and do something!
Medicare paid $37.14 on Friday for a level 3 OV. Today they will "allow" $30. Oh, and the 5 page form that the doctor is supposed to fill out for the $15K scooter? Zero.
I have witnessed plenty of medicaid fraud - my sister called to ask the home health agency to come out after the nurse had canceled her weekly visit. The agency said that the nurse had already billed and filed notes for a visit that never happened. After investigation, they were able to document dozens of fraudulent home health visits this nurse had billed for.
The truth is, fraud happens. Knowing someone is holding you to a standard improves the quality of your performance. Get involved to make sure that if they put this in the bill that the "punishment fits the crime."
This idea of spying on doctors made by this politician and colleague it just proves how determined our representatives are to get into our lives,to control us and to devaluate the respect of the people for our profession. Dr. Coburn probably does not need to practice medicine anymore and to be paid a mediocre fee. In the other hand if his idea gets implemented this would be a good push for many of us to finally consider to get out of Medicare. If they want to crack down on Fraud they can be very successful if the investigate offices and clinics that suddenly start billing for multiple services that are not generally on the scope of the doctors' specialty or that grossly deviate from the usual billing patterns of the doctor.
"checking up on Medicare/Medicaid recipients to see if they continue to qualify for benefits?"
Also, consider checking the deceased whose relatives/friends/nursing homes are still receiving benefits from Medcaid, Medcare, and Soc. Security as well.
You get the picture. The more the government becomes involved in medical care, the less of a physician/provider to patient relationship will exist, the more lawsuits will occur, and the fewer good physicians we will have (who would want to work in that environment?).
Sen Coburn is a doc in name only, and represents us about as well as the AMA.
It is certainly a waste of resources.
I can tell you that I turned more patients away or refused to do their surgery because they could not make the commitment and excercise their end of the bargain i.e. personable responsibility for their health by making the changes.
Now i'm sure they just went on to find a "center of excellence" were they were more than happy to operate if the patient just jumped throuth the hoops and met criteria.
Down the road there was a small hospital that started doing lap bands and I was told by several patients that I had seen that didn't even qualify by BMI standards when they saw me, that when seen by the lap band surgeon they were accually told they had to gain "x" # of lbs to be considered for surgery and then to come back. One patient was told she had to gain 40 lbs. and did just so she could have the procedure because her original motivation was to loose 30 lbs.
So, surgeons telling people how to qualify for an operation that they are not a candidate for just so they will eventually be able to qualify for it.... I guess medicine has become a business and some physicians are willing to do irresponsible things to get more cases and boost income.
I'm not sure undercover patients is the answer but something shoud be done to ferret out these hacks who will do what they need to keep the steady flow of patients coming.
Too many top politicians on the Right have adopted this political tactic, making grandstanding inflammatory remarks in order to derail substantive debate. A US representative from Minnesota accused the Obama administration of causing the Swine Flu epidemic. A US Senator had his family build an igloo in the DC snow, to jeer at Al Gore's position on climate change. Another US senator remarked that it was "understandable ..." that a nut enraged about tax policy flew his plane into a building and killed other US citizens.
I'm really, really worried about where the US is headed, if we can't talk sense to each other.
I couldn't find an ICD-9 code for "government employee pretending to be a patient with ficticious complaint"."
Let's advocate undercover pages in the senate!
Let's advocate undercover cabinet persons in the White House!!!
The notion of putting "undercover" patients in the clinical setting like this is just wrong.
How about they simply look over all hospital billing statements for 12 months? There's tons of excessive and "creative" misuse and abuse there.
How about they monitor simple things like when MAC anesthesia is used. In what medical situations is it truly appropriate and necessary? This is real example of an area of abuse,....that should be very easy to evaluate and cut back on,...with regard to its unnecessary use. It's used for a larger and larger % of simple diagnostic GI endoscopies....costing ~$500 and up per patient. It's being used for "office procedures" like EVLTs. Just at our rural hospital, where only three docs do endoscopies....it's costing our local community an extra ~ $250,000 per year.
Or, if this irritates some and reduces their "take home"....then relax the restrictions on its use and allow RN's to certify to give it.
Multiply this 'misuse expense' by hundreds of other hospitals in our state...most much larger than our 28 bed facility.....and you've got a great deal of excessive charging going on. AND this is but MERELY ONE example of MANY.
Medicine / medical insurance / malpractice --- needs real competition,....open insurance sales borders,....a direct seller/purchaser relationship between the insurance company and the insured, ......and meaningful tort reform. Why not simply start with these four? It wouldn't take more than 50 pages or so of legislation!!!
Instead of taking care of real issues, these dems and reps. are just busy in making their political careers secure. Why don't they bring the proper tort reform and stop the blood sucking lawyers from suing physicians frivolously? This will bring the cost of malpractice premiums down. When doctors get a sense of security, they won't order unnecessary tests to cover their back. Patients should also realize their responsibility and take care of their health as much as they can instead of solely relying on physicians to perform miracles. I mean, we are doctors, not car mechanics where you can bring your broken car and ask them to fix it without taking any responsibility. I just feel that no political party be it Dems or Reps. are interested in carrying out a proper health care reform which should and must include tort reform. They keep talking about how bad the health care is in States and talk big things but when it comes to doing something and make a change, they want to avoid all real issues and bring only cosmetic changes with these kind of stupidest ideas thrown in by someone who has an MD after his name. Disgusting..........
Sen. Coburn........you have disappointed us. In fact, let us down.
Paranoia and needless postings end unceremoniously.
Get a life people.
Anyway if you really want to lower health costs, close the medical schools and the Hospitals and all the clinics, Place a Priest and a Nurse in every pharmacy and the patient will have something prescribed by the nurse, get blessed by the Priest and go home. This will only work if the pharmaceutical companies do not raise the price of their meds by 10-fold, otherwise it might wind up costing more!. Oh Well.
It goes like this. This is going on already in pilot states.
OK agent Bob. You are going to go into the doctors office. If you can come out and testify that the doctor checked a box that you don't think was accurate, we will fine that doctor 10 thousand dollars, and you get to keep half of that! Two boxes, double the money. Three boxes, triple the money! Agent Bob, you can make 15 thousand dollars in just one doctor visit!
GO get em!
Can you imagine the field day for politicians and the media frenzy this kind of stuff will bring about?
This goes beyond 1984. Well, yes this was 26 years ago. We should be getting used to it by now!
It is a question of criminalizing the patient doctor encounter if it is not to the 'standard' of a government entity. So, everybody who is pro this policy should consider a real possibility:
Dr. Palenstrat has a political presence. Obama disagrees with Dr. Palenstrats' ideals and wants to make them disappear. He will then send off a herd of 'undercover patients' to 'objectively evaluate' Dr. Palenstrat's practice.
Behold, Dr. Palenstrat is not documenting nor asking clinically nonrelevant FH ancestry information on his patients which was clearly a necessity in order for the billing codes that Dr. Palenstrat is using. He did dis on all of his encounters! He had 100% noncompliance and was committing 100% billing fraud! Well, Dr. Palenstrat's license is very much at risk here, but lets hope that Dr. Palenstrat has a good attorney that will keep him out of prison!
Don't laugh, it could happen, and it could be you! Certainly, our medical political leadership would be at the greatest risk.
So, please do not agree with government Criminalizing Patient Doctor Encounter. It is bad for you, bad for patient and bad for democracy.
This may not certainly be the best tactic - but I'm all for identifiying and punishing crooks.
My head spins with regulations. I think anyone in favor or more rules must have the new and improved Autism spectrum disorder. Such compulsiveness at the expense of reason is not justified. Perfect is the evil of good.
No thanks.
No one would argue that there are bad apples in all walks of life, we are no different. We could all name someone that probably this applies to, but I can name infinitely more that it does not.
It is not the prescence of poor docs, or defining them that bothers me. It is the means and violation that does. Lets be frank....Whatever the gov't starts something, it nevers stays that way, and eventually becomes bastardized into something uncontrollable, unfair, and prosecutorial.
I am a firm believer in the thought "what goes around comes around", so if there are abusers out there, judgement day will come. But the gov't should not assume the role of God/judge and jury etc....
In the midst of all of this healthcare talk, the gov't run postal service has just made the decision, that they will no longer delivery mail in Saturday. They can't afford to do this, as internet mails has robbed them of revenue. It is hard to believe that such a well run outfit as the USPS, can't weather internet technology. Why can't der Furor, fix that gov't run program?
Would I like being checked out? Nope, of course not........I guess that I might be a tad less sensitive to this than the next guy/gal....perhaps because I was in the military for ten years and Big Brother was sort of a way of life for me.......I don't know......if I had to vote on it, I'd definitely vote NO but if it going to happen no matter what, it would just be "business as usual" for me every day.
Don't get me wrong, I would DEFINITELY screw with them somehow if I figured out who they were...... ;)
Amen. Thanks to you for your service in the military.
I would wonder how the AFL/CIO would respond to this type of "oversight" and quality "enhancement". It would seem to me that the unions big-wigs would be sweeter targets, but of course they are also the second biggest campaign contributors to the Congress/President.
I've had others demand I bend the rules, take someone else's ID as theirs, write prescriptions in false names, bill for services I didn't perform. I always refuse. I am sure some of these "patients" were really government agents so as I said .... nothing new.
My response - just practice good medicine and don't fall for this crap.
BTW, a lot of the the newly found billions in Medicare fraud has very little to do with criminal intent- it is from a going back and re-defining of "stuff we really shouldn't have paid for"..such as a procedure that had complete documentation of medical need and necessity, sending in practically the entire patient chart along with the bill, but one of the 16 signatures was now deemed illegible..or not dated and timed...
"blackwater (now called, mysteriously, "Z")"
Is this for real (I thought Z was for Zorro)?
1984 has been here....
How many Congressmen cheat the system every day??
It isnt about good medicine. If that were true, you would never have a medicare audit or be denied a claim. The vast majority of docs don't cheat the system, dont try to do so, nor do they fraud their patients or payors. Yet, most of us would not invite a medicare audit....why? Because we all know that undertrained, non-medical, henchmen will review your charts, and if 1 thing is out of place it = fraud. We are human like anyone else. Unless you document the same exam for every patient, you charting will change based on the sx/pt etc. You may not say or write something that you assume to be self evident....therefore it never happened and you never thought of it. You have to be a computer to remember ALL aspects of EVERY scenario, and none of us do that, we simply cannot.
Therefore, if rigged patients are intentionally sent, to audit our practices, and the threat [guilty or not] of gov't sanctions, fees, penalties, and most of all fraud attached to your name should raise concerns, particularly when it isn't true. And don't forget, you pay first, are assumed guilty....THEN you can appeal the decision. What other faction of business or private enterprise is guilty until proven innocent? You don't have to be guilty of anything to be charged or fined, you simply have to be human and we all are. How do you think RAC "recovered" 900 Billion in NY and TN in 1 year? Do you really believe that so much fraud/abuse had occured to equal that amount. It is also interesting, the no mention of what constituted that 900 Billion ever hit the presses. The only think printed was the dollar value, I would suspect there are heavy appeals in process, but nothing is or will be said of any reversals, that you can be sure of as it would be indicative of erroneous judgements by CMS and their hired/fee for service guns [RAC Auditors].
I am not paranoid, I am concerned of unfair characterizations that require time/money to reverse [if suspected], and cause irreparable damage to our names and character. It is not paranoia to suspect that there is a motive behind this kind of practice and where there is motive, there is money. Where there is money, there is the definite possibility of unscrupulous behavior. If I am not mistaken, one reason for the many Stark regulations is to deter such behavior amongst the greedy doctors/hospitals. If medicine is thought to be capable of such graft, would that not apply to RAC/undercover agents etc???
No one is arguing that is hasn't happened, and no one is asleep at the wheel either. The concern now is the scope, volume and pure motive behind the "upgrade" that will occur.
In the past there had to be firm concerns and "reason", that will no longer be the case. It will be a compulsory part of medicine, as a private business will be hired to specficically garner money, of which they get a piece. As it stands now, that "program" is federally run, with federal agents, and sparse. That would and will all change.
The bottom line is don't take insurance and 90% of this type of problem disappears.
sneeking. The 3rd party medical people are ruining the industry.