Monday, August 27, 2012

Medicare Stopped Paying Me--Why?

     Immediately after the raid on my clinic, Medicare stopped paying me for clinic services.  Nor did they pay for outstanding claims left over from prior months.  Half my patients at that time were covered by Medicare.   The loss of income for the clinic, compounding the bank account forfeitures, was paralyzing.
     My billing staff and I made dozens of calls to Medicare asking why they had stopped paying us.  Our outstanding claims totaled hundreds of thousands of dollars.  Our phone calls were picked up by receptionists who "took messages"--Medicare officials did not call us back for many weeks, then were vague, saying they "needed documentation" for our charges, or didn't know why we weren't getting paid.  On several occasions we reached Myrtle Gordon or Brad Smith, our representatives at First Coast Medical (the local Medicare service provider located in Jacksonville), but told us absolutely nothing.
     Medicare then placed my clinic on a 100% review.  This means that they required us to send claims for patient services via the electronic claims transmission program, and wait several weeks for a response.  The "response" was a form letter for every patient visit--in fact, for every item we billed--requesting documentation that the services were all, in fact, provided.  We were sent thousands of form letters, including many duplicates, for which I needed additional staff to sort.  Each letter requested copies of every page in the patient charts, before payment would be considered.
     It was an absurd game.  My front office staff copied all the documents and sent them, as required, by snail mail to the First Coast Services office.  Still, we received no payments.  Phone calls were not returned.  Our e-mails must have been lost in transmission, or ignored, because they disappeared into cyberspace.  Multiple phone calls, week after week, went unanswered.  I made calls, and reached authorities twice, insisting that I be given either an explanation for non-payment or be paid.   The response was "I'll look into it and get back to you."  No one ever got back to me.
     I wanted to raise this problem in my court case, but my lawyer,  Curtis Fallgatter, said it wasn't relevant.  He seemed not to appreciate the necessity of being paid for services--except when he demanded a fee of $26,000 more than the $20,000 retainer he had already received, just before filing my motion for emergency relief.  ("I need to be paid for my work," he said.)  ("He has a reputation for obscene overcharging," another Jacksonville lawyer later told me.)
     The hearing failed to reverse the terrible effects of the government's raid.  But afterward, when the court reporter had closed her stenotype machine, I insisted that Mr. Fallgatter ask why Medicare had frozen all payments to my office.  The prosecutor and FBI agents were poised like military personnel along the mahogany-stained courtroom wall to the right of the judge.
     "I have no idea," answered Robert Murphy, the lead FBI agent, whose height accentuated his hubris.
     "Has the government instructed Medicare to stop paying Colasante Clinic?" asked Mr. Fallgatter.
     "Not that I know of," the agent said.
     "Ask him to find out, and to promise to give us an answer," I whispered to Mr. Fallgatter.  "Tell him the survival of the clinic depends on it."
     "He doesn't care about that," Mr. Fallgatter whispered back.  "He might be glad to see you shut down."
     "Can you look into this dire situation?" Mr. Fallgatter asked with a degree of formality that seems cartoon-like to those of us who don't spend much time in stately courtrooms.
     "Yes, I'll do that," Mr. Murphy answered.  He seemed to be repressing a yawn.
     "When can we expect to receive an answer about this matter?" Mr. Fallgatter pressed.
     "Within the next few days," said Mr. Murphy, gathering his belongings.
     That's when I approached the two prosecutors, Bobby Stinson and Corey Smith, who stood to the left of Robert Murphy, and addressed all three.
     "Thank you for assisting me in my efforts to leave the field of medicine and pursue another line of work," I said to them with wry satisfaction.
     There isn't much suspense to this story.  Of course we never heard from Mr. Murphy about this matter again, not without several phone calls.  I was not permitted to call him--perhaps because I might give away some clues?  But Mr. Fallgatter did, at my insistence, and I was told that the government had not put any obstacles in the way of Medicare payments to us.
     "Just between you and me," Mr. Fallgatter said, "there is a lot of inter-agency communication."  He said he wouldn't be surprised if the government had indicated to Medicare that my account ought to be flagged.
     I continued to see Medicare patients for the next six months, as we were given blandishments--"We don't see anything wrong....There's no hold-up on payments."
     "Why are we on 100% review?"  I wanted to know.
     "Oh, it's routine," was one cryptic answer.  A 100% review is tantamount to a shutdown for clinics such as those in Florida, which has a high percentage of Medicare-receiving residents.  It is not "routine."
     Medicare owes my office more than a year's worth of payments.  None of the thousands of flu shots we administered were paid, for instance, nor were EKG's, chest x-rays, IV antibiotics for pneumonia and cellulitis, surgical procedures...nothing.
      Every week I wrote certified letters to Medicare administrators, demanding an explanation for their so-called "review," which seemed nothing more than a pretext for withholding money.  In these letters I invited Medicare officials to visit my office, or send coding specialists.  I would open charts for them so they could explain what was missing, why they were not paying for my work.  I didn't want to close the doors to my long-time Medicare patients, whom I knew so well, but I couldn't afford to keep treating them for nothing.
     Finally I received a certified letter back, then another!
     "Stop writing us letters," they said.  "We will no longer accept any of your letters.  We will never be making a visit to your office."  The letters were signed by Brad Smith.
     After that, I had to explain to my Medicare patients that I could not take care of them any longer.  "Why?" they asked.  They pleaded with me.  Many wanted to pay cash--but that's illegal, since my clinic still qualified as a "Medicare provider."
     Many of these patients were irate, and said they were going to call Medicare to complain.  If they ever got through, I sure would like to know how.
     

4 comments:

  1. I am a former patient that has been following your blog. It has made for some interesting reading. You mention that your current problems are associated with the sale of your Hawthorne clinic. Which leads me to ask, why hasn't the FBI seized records associated with your Hawthorne clinic? I recently requested my records from the storage company and they were immediately available.

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  2. Last year I learned that the FBI did, in fact, seize the records from the Hawthorne Clinic Pat McCullough bought. Perhaps they made copies of them--but there were 8,000 patients and hundreds of thousands of pages of charts, so it's hard to imagine they confiscated all of those.

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  3. THERE IS A SPECIAL PLACE IN HELL FOR WHOMEVER IS RESPONSIBLE FOR PUTTING YOU, YOUR STAFF, YOUR FAMILY, AND MOST IMPORTANTLY THE PATIENTS WHO LOVE AND ADORE YOU, AND HAVE NO RECOURSE OTHER THAN TO DO AS THEY ARE INSTRUCTED BY THIS OUT OF CONTROL LAW ENFORCEMENT???? SYSTEM OF OURS.

    GOD BLESS AND GOD SPEED.

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  4. So far, you've mentioned financial losses. Is there any chance you could be imprisoned?

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