They can't find their asses in the dark with both hands, but they CAN find fraud.

I know these guys and the are smarter than this.

https://www.houstonpublicmedia...edures-to-residents/


RMD

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They can't find their asses in the dark with both hands, but they CAN find fraud.

If not for the whistleblower, the fraud would still be continuing.

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I know these guys and the are smarter than this.

The money clouded their brains.

Some years back my girlfriend's doctor was caught billing Medicare for procedures not performed on many of her patients, including at least once on my GF. The doctor fled the country (back to India), but came back a couple years later and set up another practice in a town less than 50 miles from here.

I don't know who keeps track of these things, or if the doctor is still here. I suppose it should be up to us to drop the dime when we see this sort of criminality.

A few years ago I went to a physician in a single-provider specialty practice.

Every visit -- EVERY SINGLE VISIT -- I sat on my ass in the waiting room for an hour or more past the appointment time.

With some doctors, there might be an excuse re emergency, but this specialty was not the type to have emergencies, it was plain overbooking, to milk maximum billing every day.

The fourth time that this happened, I unloaded on the doctor. Basically told him that he was fired, and why, and as I walked out, I advised the desk person NOT to charge me nor Medicare for that visit.

Next month when my CMS summary arrived in the mail, I saw that there was a charge for the visit. I reported it as fraudulent billing, since no services were provided, and specifically, the services that were coded and claimed were definitely not provided. CMS person took all the details, I never found out what, if anything, happened.

Mrs Highlander works in fraud detection, investigation & analysis. It amazes me how many smart, successful people risk everything for a few extra dollars. On the other hand, a lot of prosecutors don't want to tie up the resources required to bring charges.

I saw an episode of Gray's Anatomy that was similar.

I had a GP who wouldn’t treat something other than what I was originally schd to see him about. For instance, I go in regarding a sprained wrist and say: “Since a made this appt 2 weeks ago. I’ve developed an intense sore throat and cough. Will you take a look?” Reply would be: “ No, this appt is for the wrist, you’ll have to make a separate appt for the sore throat and cough!” I understand that his time was limited but I’d never experienced an attitude like that. Figured he was charging medicare for visits. My RN wife was outraged. We fired him.

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With some doctors, there might be an excuse re emergency, but this specialty was not the type to have emergencies, it was plain overbooking, to milk maximum billing every day.

^^^^^^^^^^^^^^^^^^^I
In many instances it is the patient that does not show up for the visit. You can charge the patient for the no show,but they get pissed. My dentist and physician charge for no shows which is OK with me.

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Originally posted by ZSMICHAEL:

You can charge the patient for the no show

Charging for no-show is fine; the quack makes his money whether or not the patient shows up, so there is no excuse for the outrageous level of overbooking at the practice that I cited.

There’s a very disturbing trend that starts with billing for unnecessary practices and evolves into overprescribing opioids /and/ billing for visits, testing, or even patients that don’t exist. It usually takes getting into the millions before you catch the attention of federal agencies and at that point it grinds slow but grinds fine. I’m always amazed that relatively smart people don’t figure out it’s safer to keep it low and small… I suspect it’s so easy that people start spinning out and either can’t control it or deep down want to get caught.

Any plan that potentially involves an adversary with unlimited time and resources is generally a bad idea.

Rick Scott was head of Columbia/HCA when it paid a record 1.7 billion dollar Medicare fraud fine. Scott went on to be the Governor of Florida and is now US Senator Rick Scott. Worked out for him.

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Originally posted by maxdog:
I had a GP who wouldn’t treat something other than what I was originally schd to see him about. For instance, I go in regarding a sprained wrist and say: “Since a made this appt 2 weeks ago. I’ve developed an intense sore throat and cough. Will you take a look?” Reply would be: “ No, this appt is for the wrist, you’ll have to make a separate appt for the sore throat and cough!” I understand that his time was limited but I’d never experienced an attitude like that. Figured he was charging medicare for visits. My RN wife was outraged. We fired him.

I work in a speciality practice, and this is actually our official policy- you get seen for the issue you booked the appointment, if you want something else addressed another appointment is required. I myself mostly ignore the policy and try to cover as those extra “oh by the way” concerns as much as possible. I can tell you however, when you have a full schedule and pre plan your every move based on the primary reason given for the appointment often those “oh by the way” things end up taking more time than the original concern and can really dig you a hole time wise that then puts you behind for other scheduled appointments.

Yeah, that's why they should get audits and be controlled more. TPE audits are a perfect example of that.

This message has been edited. Last edited by: ammodotcom,

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Originally posted by captain127:

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Originally posted by maxdog:
I had a GP who wouldn’t treat something other than what I was originally schd to see him about. For instance, I go in regarding a sprained wrist and say: “Since a made this appt 2 weeks ago. I’ve developed an intense sore throat and cough. Will you take a look?” Reply would be: “ No, this appt is for the wrist, you’ll have to make a separate appt for the sore throat and cough!” I understand that his time was limited but I’d never experienced an attitude like that. Figured he was charging medicare for visits. My RN wife was outraged. We fired him.

I work in a speciality practice, and this is actually our official policy- you get seen for the issue you booked the appointment, if you want something else addressed another appointment is required. I myself mostly ignore the policy and try to cover as those extra “oh by the way” concerns as much as possible. I can tell you however, when you have a full schedule and pre plan your every move based on the primary reason given for the appointment often those “oh by the way” things end up taking more time than the original concern and can really dig you a hole time wise that then puts you behind for other scheduled appointments.

Us as well. Ins often WON’T cover that extra little surprise, and when you try to bill it, they write it off, stating you cannot bill said services on same day (depending on what type they are). We often eat it and the patient never knows we just saw them for free. It’s a double edged sword.

The local clinic at the Air FOrce base has the policy of one complaint per visit. No exceptions. A lot of these guys enter private practice and apply the same principles. They quickly find out that this stupidity does not fly in private practice,

I would like to think that these people are doing it to find a life saving surgery for a family member or some other catastrophic illnesses. In reality it's all about a few extra bucks. I don't know the particulars, but if it's as cut and dry as it appears, then why are these people still practicing medicine?

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I don't know the particulars, but if it's as cut and dry as it appears, then why are these people still practicing medicine?

Jesse

Sic Semper Tyrannis
 
Posts: 21172 | Location: Loudoun County, Virginia | Registered: December 27, 2014

^^^^^^^^^
Ask the state medical board. They do investigate fraud,

Overprescribing opiates is malpractice plain and simple.

Never commit Medicare fraud? Surely, you jest.

In the article, at least, the work was started by the surgeons.

There's been medicare fraud soon as scumbags figured it's a cash cow. I was managing my mother's stuff including medicare. I get this Medicare statement for thousands of dollars. I call her up and ask her about it. It was some sleep study. She said no sleep study occurred but she did remember being invited to go on a field trip from the senior center. They went in a van. arrived someplace and was given lunch. Then they drove back.

I called Medicare about it. The lady thanked me. I doubt if they ever did anything about it.