Skip to comments.Medicare Police State
Posted on 11/14/2011 9:33:21 PM PST by grumpygresh
I have been hit by a PSC Medicare audit by a bounty hunter firm- Trust Solutions of Milwaukee. I am lawyered up, any suggestions?
Move your practice to the Bahamas.
Refuse medicare patients. Explain that the risks are too high in a form letter.
For a while.
Get used to that kind of question and offer. The way things are going, you are screwed anyway, so may as well hang for a goat, instead of a sheep.
Our federal government is not only crappy, it's actively crappy. We need a reset.
You are wise to lawyer up. As a healthcare lawyer, I can tell you horror stories about the DOJ’s arrogance and ignorant view of providers. The best thing we could do would be to adopt Rep Ryan like reforms so that Medicare is run through private insurers. Civil lawyers representing private companies are far less scary than the government’s henchmen, in all their various forms—whistleblowers, recovery auditors, the FBI, DOJ, etc.
not being a smart arse, but by ‘for a while’ do you mean that eventually physicians will be compelled to?
I got hit with one of these, and I took no action...one year I received a letter saying all is well. Go figure.
Make sure that you have:
1) copy of everything that they receive as part of their audit - people make mistakes and lose things.
2) a signature for everything turned over in the audit with an assumption of liability for non-disclosure. If something just happens to get leaked during their audit to the press or third party .... well, you get the idea.
Pray...unless you are doing this already. In which case pray more.
This is part of the $500 billion saved on “waste, fraud and abuse”. They were upfront about the tens of thousands of agents they hired to target docs.
I’ve been through this and it’s unbearable. The gap in knowledge between medical people and these “coding and compliance officers” is a huge chasm. One chart was targeted because I documented the physical exam as normal in a case where I diagnosed a cough and another in a sinusitis. It was their contention this was fraudulant charges since the exam didnt support diagnosis.
On 5 more cases, they said I over billed - it boiled down to the interpretation of the word ‘edema’. They said ‘edema’ counts only for the circulatory system. ‘Lymphedema’ would count for the lymph system. I used the word edema, not lymphedema - and via the wonderful note point scoring system we all love so much, I was one point short from documenting sufficient evidence for the level of service I billed. They were willing to call all 5 charts fraudulant based on the symantics between edema and lymphedema. That was their only contention for these 5 charts I was on a tightrope for being called a fraud.
The proposed penalties I wont even get into becuase I dont want you to have a heart attack.
Simple symantic differences are not mistakes mind you, they are either found to be ‘fraud’, or correct; never a mistake.
These people carry huge leverage, massive fines, a chip on their shoulder, a mandate by their bosses to scrape as much money from practices as possible, and worse yet, insufficient working knowledge.
All = a deadly combination.
Make sure you can show some ongoing program for chart reviewing and corporate compliance at your place of business.
No wonder my doctor went Galt.
Guess she got tired of it.
Hey, medical care is free - if you can find an MD.
As Gerald Celente has said “when people have nothing to lose, they lose it” Maybe I will start journaling my experience with video. If this is really bad, maybe I will make the news.
In most national health care situations, doctors are compelled to take all patients as directed by the state, and treat them as directed by the state death panel, or lose their license to practice, some lose everything else also.
However, in these same health care systems, particularly gifted doctors are permitted a life of luxury and ease,.... for SUCCESSFULLY treating the powerful and connected only.
These same systems at best, force citizens to go abroad and pay for their own proper health care, and at worst, make it a serious criminal offense to do so, (again except the powerful and connected).
The same will happen here. With socialism doctors are worked to death and not paid, just like everybody else.
It was when I first went to see the Specialist for 'consultation' and a cursory exam for my Colonoscopy, and got the final bill. There was no problem with the Colonoscopy itself, CMS paid 80%, but CMS refused to pay for the first office visit. I called the Dr's office and they said it should be no problem as the 'Coding' was correct (he gave me the Code Number) and CMS should pay not me.
I then made the mistake of calling CMS direct. When I told the 'lady' the Code Number she had a fit, went ballistic there and then (It was like I reached the Gestapo by mistake). She demanded to know where I got that Code Number. She was almost screaming into the phone. It was like I had a Top Secret Document. All over $80.00 they denied to pay. So I'd sure hate to be on the other end - yours. Facing down these Nazis with an audit.
And I thought the IRS was bad, ha. Not even close to the CMS Nazis.
Could you elaborate? What is meant by "make a criminal referral?"
Most audits involve disputes of coding and billing. As is typical for most audits, they are triggered by a disgruntled current or former employee. The audit company also looks at the voume of your services and codes and if you are on the high end of the bell curve, you are vulnerable. Typically, the insurance company will not pay for a charge if they believe that it is improper. We had almost none of that. One must refer to the rules for coding published by Medicare and my billing staff has followed this very closely and especially for the frequently used codes.
Of course, auditors want to see if a practice has ‘fake’ patients or there were kickbacks from other doctors or between a doctor and pateint. This obviously consitutes fraud. But, the problem is that a coding dispute could technically qualify as fraud and not an overpayment under some circumstances. The probelm is that we do not know what ‘some circumstances’ actually means. So, right now we really do not know what actually is going on. This creates a great deal of uncertainty and a complete lost of trust in the Medicare system.
I have stopped taking new Medicare patients as a precaution and we have told existing Medicare patients that they should find another provider because we are strongly considering de-participating or becoming a non-participating provider.
This is one more reason that doctors will refuse to participate in government health care. Sure, some doctors will become employees in large hospital systems so as to avoid these hellish regulations. But others will simply cease accepting government insurance further exacerbating the supply of physicians.