[Info-vax] Down Again

[DaveG]

On Aug 13, 4:03 pm, seasoned_geek <rol... at logikalsolutions.com> wrote:
> 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.

What a sad sad story.  There are probably (many) others and some bad
ones too.

And I often wonder --- why does the insurance industry practice
medicine w/o a license?