[Info-vax] Down Again

DaveG david.gudewicz at abbott.com
Fri Aug 14 09:48:54 EDT 2009


On Aug 14, 8:44 am, DaveG <david.gudew... at abbott.com> wrote:
> On Aug 13, 4:03 pm, seasoned_geek <rol... at logikalsolutions.com> wrote:
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> > 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?- Hide quoted text -
>
> - Show quoted text -

I meant to say "some good ones too".  Sorry.



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