Posted and filed under Commentary.

Two weeks ago, we featured a personal story of mine and related it to Elizabeth Holmes and a Mount Carmel doctor who was found to deliver inappropriate medications in a deadly way

Thank you for those of you who responded.  Interestingly enough, one person sent an email about a healthcare provider who is thought to be upcoding and bullying seniors.  We see and hear bad things each day, but what can be done about it?

When we hear about therapists seeing a group of patients (group therapy) 4-5 at time for an hour, and bill each patient individually for an hour at a Veterans Hospital – what do we do?  300 minutes billed per hour is not right.  The patients do not receive the treatment they need.  It is so sad that we treat our seniors and vets this way, the reason we have what we have are the people who came before us and served our country.  When it comes to their healthcare, do we do enough to support them and say thank you? 

Well, we cannot ignore it.  We do not just want to get frustrated and talk negatively about how the system is broken. We want to help and get to the bottom of it so it can be minimized.  If you have ideas, please call or email me (407.583.7379/jloria@advizehealth.com).  We understand providers want to get paid and that there are loopholes and inefficiencies, but at the same time, with all the bloat and confusion, care and patients suffer.  We see it most with seniors, with cancer patients, with people who receive services around pain management.  It is sad to see poor care. 

Back to the provider with the upcoding and bullying seniors – after receiving the tip, I sent it to three healthcare fraud people I respect to see what they would do with the information.  Count me in…drum-roll please.

  1. “Nothing other than tell [the person] to contact the OIG hotline.”
  2. Spoiler: I like this one, it gives some great homework options:
    “As far as the individual practitioners you are concerned with go, I would look at their medical board history to determine if they have any prior history related to their prescriptive practices.  Compare that to any medical documentation you have that demonstrates similar conduct and maybe make another complaint to the Board.  You can also do some data analysis using the recently published 2019 Medicare Provider Summary data from CMS and see if they are outliers in their specialty.  If they are an outlier or just appear to have billed a large amount, it could increase the appeal for the Board to investigate since it could evidence a quid pro quo relationship with patients.  I am attaching a link to the data for ease of reference: Medicare Physician & Other Practitioners – by Provider – Centers for Medicare & Medicaid Services Data (cms.gov)

    If you could find out who the physicians are then you could potentially look to see if available public data supports the allegation.”
  3. “Without knowing all the specifics it’s hard to say.  Even knowing the specifics, we can’t just audit them or suggest to audit them.  If the person knows a ton of information and specifics on this, we can suggest a qui tam.”

I am hopeful that this helps our readers get some ideas for their personal networks to not just accept poor care for their underserved family/friends, but to also internet sleuth some providers for themselves.  Yes, Michelle McNamara, the famous true crime author who helped find the “Golden State Killer,” is home run of internet sleuthing, and latest “Couch Guy” viral TikTok shows how internet sleuthing can be toxic

We all have stories about the crazy ex who put the wrong timeline together based on social media and sleepless nights of sorrow, and rather than fact-checking, went on to send nasty happy holidays emails.  So rather than just getting dangerous with allegations, we can start collaborating together to look at data and real doctors – maybe we can stop some bad actors together.  My phone and email address are above, hit me up already and let’s do this.

PS – if you haven’t read or watched the documentary I’ll Be Gone in the Dark, please do yourself a favor and get that done this weekend.

By: Jeanmaire Loria