[Info-vax] Down Again

seasoned_geek roland at logikalsolutions.com
Thu Aug 13 17:03:48 EDT 2009


Many many years ago, in my yoot, I worked for a peer review
organization which did quality of care and cost analysis for Medicaid
and Medicare.  It was not for profit and came to a screeching hault
during one of the constant funding problems the state had.  I was a
quality of care programmer writing all of the reports and indexed file
entry programs to track quality of care issues from the review
process.  There were a fleet of nurses in the field looking over
samples of patient folders looking for things that seemed odd.  Those
folders would find their way to the home office for physician review.
Issues went from rank-1 (documentation) all the way up to rank-4
(gross and flagrant) where there was a high probability we would
recommend the revoking of a license.

Occassionally we would get specific requests from Medicaid and
Medicare to review billings that were out of the ordinary.  Not that
they tried to over charge the agency, but the same medical license was
seeing patients in two different states on the same day.

There is one case I will never forget.  Just such a request came in
asking for a review of charts and invoices filed by a license number
which appeared to be practicing in IL and ... some extremely backwoods
remote area of either Mississippi or Kentucky.  It had been going on
for about a year and they wanted a detailed investigation since our
cursory transposition of digits check didn't turn anything up.

I have never felt so bad for someone or seen such a misscarraige of
justice.  It turned out the doctor had been working in IL and shared
office space with another doctor (whose license number he was now
using).  They did not share filing systems or clerical help.  This
particular doctor had hired clerical help that apparently had no
concept of the alphabet or patient folders.  There had never been a
single quality of care complaint logged against him, but a year prior
some random inspection of patient records found now two folders in the
office actually contained records for only one patient.  I don't
remember all of the details, just that his license got pulled as a
result.

Usually, when a doctor gets a license pulled but keeps on practicing
medicine it is greed or ego (usually both).  Not this dude.  He picked
up and left an upscale suburb for a place that shows up on those
"could it really exist in America" news clips you see during sweeps
week.  This time he apparently hired a clerk that could handle all of
the filing and billing.  Once again, not one single medical quality of
care issue turned up.  Had the billing not triggered a fraud sensor he
would probably still be practicing today.  He was the only doctor they
had and pretty much everybody was either on some kind of government
healthcare or seeking charity care.

I think of this story when the healthcare debate comes up.  A doctor
who had sh*tty office help got his license revoked.  He tried to do
penance by providing great care in a place which had no doctor.  He
still got prosecuted.

A 16yo kid, having no medical schooling what-so-ever,  can sit at a
desk in an office a deny you life saving emergency treatment.  Neither
they, nor the company that hired them can ever be sent to prison for
practicing medicine without a license.  On a basis of nothing more
than quarterly profits, they have their own little built in Euthanasia
board.

I actually have a blog post written, just not posted yet (Karmic Koala
having issues with OpenOffice Weblog), titled "Soylent Green is
People"

If we don't completely re-invent the healthcare system, we should hit
the "Soylent Green" time-line just about on schedule.




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