September 5, 2011
The Scam of Matthew Scheidt and How it Affects You
Did you hear about the 17 year old teen that posed as a physician assistant at a Florida hospital for five days and got away with it? Are you surprised? I’m not.
It seems that Matthew Scheidt, had a summer job working part-time for a surgical supply company. He allegedly went to the Human Resources Department of the Osceola Regional Medical Center (ORMC) and convinced them that he was a Physician Assistant student at Nova Southeastern University and lost his identification badge. This is the hospital where many of my former patients were forced to go for medical care because they were either uninsured or received Medicaid. My former employer had a fiscal relationship with them. The use of the word “forced” is quite appropriate because my uninsured patients had no options. When those who had Medicaid requested to deliver at a women’s hospital in another county they were discouraged to do so by the powers that be. I recall with great pain the memos, reprimands and threats I received from my former employer because I wanted to give my patients the freedom of choice. Oh, the stories I could tell about the numerous altercations I had with certain staff members regarding patient management issues. So the fact that this hospital is now on local and national radar screen does not surprise me at all. The hospital was formerly owned by the organization that Florida’s incumbent governor once worked for and eventually paid fines because of fiscal improprieties. The hospital’s long-standing former administrator resigned once the governor ran for office. Yes, politics indeed can affect patient management. But let us return to the story of Scheidt.
Scheidt allegedly performed CPR, changed IVs, cleaned wounds, performed interviews and physical exams on male patients who were disrobed. He was also in the operating room. He only got caught when he asked permission to go to “restrictive areas” of the hospital and I pray it wasn’t the labor and delivery suite. How did this happen? Because our healthcare system is presently on automatic pilot. There are no checks and balances. No accountability. A 17 year old can show up in the human resources department of the hospital and no one does a background check to verify his credentials. Pity the poor patients. This is one of many reasons why The Smart Mother’s Guide to a Better Pregnancy (TSMG) was written. Patients need to be protected.
Could this happen to you? In a heartbeat if you’re not astute and aware. There is a chapter in TSMG, called Investigating the Places Where You Will Receive Care. I strongly encourage everyone to read it.
October 7, 2009
SMART Tips on Reversing a Denied Health Insurance Claim
I’ve had more than my share of frustrations in the past when I’ve had to battle insurance companies about needed services for my patients that were either denied or “not covered.” My daily intake of blood pressure pills is a constant reminder of the stress that accompanies my job. However, I have recently looked at insurance companies through a different set of lens and I was a little surprised at the view. Sometimes the denials are not the result of stonewalling, but on the incompetency of a provider’s billing clerk.
I had a $600.00 dental bill for services that was denied by the insurance company. Because I took the denial on face value, without further investigation, I made payment arrangements, assuming that the services were not covered. I was wrong. While researching my son’s services, I discovered that my dental services had been erroneously denied because (a) the dentist’s office erroneously billed for my upper teeth rather than the lower teeth and (b) they failed to submit information regarding my recent extraction that would validate the procedure. The same thing happened when my sons’ pediatric services were denied. I contacted the insurance company directly and discovered that their pediatrician’s office had used the wrong billing code thereby giving me a liability of $814.37. Both billing errors could have cost me $1400.00.
The lesson learned was that insurance companies will pay for services if you follow their rules of engagement.
S–Seek answers. Never accept a denied insurance claim based upon its face value.
M–Monitor the “procedure” codes used on your billing statement in your provider’s office
A–Assume someone made a billing error when you receive an insurance denial.
R–Respond to denied claims immediately. Don’t let them sit on your kitchen countertop unattended
T–Talk to your provider’s billing department as soon as you discover your denial was based on their error.
An insurance denial is not written in stone. Most insurance companies are quite willing to pay the claim, once the error has been corrected. Following these steps might save you significant aggravation and money in the future, not to mention the disappearance of an uninvited headache.
September 7, 2009
National Infant Mortality Awareness Month
Did you know that nearly seven babies will die before their first birthday for every thousand who are born in the U.S. and the rate for African American, Hispanic and Native American women, are even higher? Premature births occurring before thirty-seven weeks and low-weight babies, weighing less than five pounds account for the highest number of deaths in the U.S.
In recognition of September as the National Infant Mortality Awareness Month, I’d like to share some SMART tips to pregnant women:
S = Seek prenatal care early. Problems in pregnancy cannot be fixed at the last minute. Tests for genetic problems can only be detected in the early first and second trimesters. A first trimester ultrasound is also the MOST accurate in terms of a due date.
M = Mention all high-risk factors such as family history of diabetes, high blood pressure or bleeding. Do not omit information such as smoking or “recreational” drugs. It will come back to haunt you.
A= Ask to have your cervix measured during your ultrasound if there is a previous history of premature contractions or delivery. A cervical length of 2.5 centimeters or less is a risk factor for preterm labor.
R= Research your hospital and prospective physician or midwife carefully. Is the physician or midwife skilled in managing high-risk conditions? Will they continue to see you even if you lose your insurance? Has the hospital had any recent outbreaks of antibiotic-resistant – infections in the newborn nursery? Is there 24-hour anesthesia?
T= Test for potential problems such as Gestational Diabetes, Sickle Cell Trait or sexually transmitted infections.
The U.S. is one of the most industrialized countries in the world, yet we rank below Cuba and Taiwan, with respect to our national infant mortality rate. The health of a nation is judged by its national infant mortality rate. We can do better. We must do better. The health of our future generation is depending on it.
June 30, 2009
In Search of Integrity
There should be a litmus test for ethics and integrity so that the landscape of our country could look vastly different. There would be no healthcare crisis, no financial collapse, no housing foreclosures or unnecessary deaths because of pain medication addiction. The misfits seeking positions of power would be duly eliminated before they created havoc.
The death of Michael Jackson documented an ever expanding reality that gives me great pain: some doctors will do anything for the pursuit of money, even at the expense of human life.
During the course of my medical career, I have witnessed and have had to report colleagues who have crossed the line for the sake of their bank accounts. The colleague who supplied his cocaine habit by doing unnecessary surgery and fraudulent Medicaid billing. The physician who paid his cronies on a per-patient-basis and turned a public funded healthcare facility into a money making factory. The “deals” made by colleagues that violate conflicts of interests. Hippocrates is probably rolling over in his grave.
I will not write fictitious sick notes, fraudulent disability claims, fill prescriptions for people without a medical chart and am fiercely protective of my DEA license. My medical degree is not for sale. There are times when I have not been the most popular physician among my colleagues but at least I can sleep at night. I wonder if the physicians of Heath Ledger, Anna Nicole Smith and Michael Jackson can do the same.
The seduction of money comes with a heavy price. Just ask Michael Millikan, Ivan Boesky, or perhaps, the clients of Bernie Madoff. Dr. Deepak Chopra had the courage to say “no” to Michael Jackson, despite his celebrity. I only wish more of my colleagues would have the decency to do the same.
June 14, 2009
A Masterpiece of Deception
How many times has the AMA betrayed physicians? Oh, let me count the ways. In 1992, they cut a deal with managed care industries and left us hanging to dry. Then they allowed our identity as physicians to disappear by calling us “providers”; poured salt into our wounds by supporting the notion that primary care physicians be replaced by advanced nurse practitioners, (thus inciting an unnecessary turf war); kept their mouths shut when “retail” clinics emerged like mushrooms manned by people who know very little about medical practice; and now rejected the progressive idea of public health insurance in support of the for-profit insurance companies. Excuse me while I remove the knife from my weary back. The lobbyists have struck again.
Without a public health component or regulatory oversight of private insurance companies, the healthcare industry is headed off the cliff. Haven’t we learned from the debacle on Wall Street? Contrary to what we would love to believe, insurance companies do NOT do the right thing when no one is looking. Just ask whistle-blower, Dr. Linda Peeno, what anguish she encountered after Humana asked her to deny a young patient a heart transplant. http://www.pnhp.org/news/2002/may/damaged_care_premi.php Or read about the FBI’s investigation of Well Care Insurance because of Medicaid fraud. http://http://online.wsj.com/article/SB124153953103687873.html
Yes, former NY governor Elliot Spitzer might have had a few indiscretions but he DID keep white collar criminals in check. Do you really think it’s a coincidence that Spitzer was in the midst of an investigation of AIG fraud and then ended up on a media radar screen? Pulleeze.
So here’s an example of what the average insurance CEO earns while the rest of our healthcare industry is in shambles:
• H. Edward Hanway, Chair/ CEO, Cigna Corp, $30.16 million
• David B. Snow, Jr, Chair/ CEO, Medco Health, $21.76 million
• Michael B. MCallister, CEO, Humana Inc, $20.06 million
• Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529
• Angela F. Braly, President/ CEO, Wellpoint, $9,094,771
• Dale B. Wolf, CEO, Coventry Health Care, $20.86 million
• Jay M. Gellert, President/ CEO, Health Net, $16.65 million
• William C. Van Faasen, Chairman, Blue Cross Blue Shield of Massachusetts, $3 million plus $16.4 million in retirement benefits
• Charlie Baker, President/ CEO, Harvard Pilgrim Health Care, $1.5 million
• James Roosevelt, Jr., CEO, Tufts Associated Health Plans, $1.3 million
• Cleve L. Killingsworth, President/CEO Blue Cross Blue Shield of Massachusetts, $3.6 million
• Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million
• Daniel P. McCartney, CEO, Healthcare Services Group, Inc, $ 1,061,513
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
If you think that a private insurance company has YOUR best interest at heart. Please, think again.
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