Monday, October 22, 2012

The Government is Two-Timing on Me

     Since there is no other possibility, the FBI raid on my clinic must be centered on fraud.  Fraud in the medical field is one of the following:

     1.  Billing for services not provided.
     2.  Over-billing/over-coding for services provided.
     3.  Providing and billing for unnecessary services.
     4.  A pattern of reckless billing, suspicious because it covers a broad swath of patients.
     5.  Billing under a false provider ID.
     6.  Pretending to have a license to provide services, when one does not.
     7.  Billing for services for which there is inadequate documentation.

However, the government and its relevant agencies assume fraud when:

     1.  A doctor bills more services than the average in his/her category.
     2.  A doctor provides services unusual for his/her category.
     3.  A doctor receives more revenue than the government thinks is right.
     4.  A whistleblower reports a doctor to the government for personal gain and,
     5.  The doctor makes more money than average and,
     6.  The government can use the statutes at hand to take back money to support
          a flagging system and appease a DOJ under presidential orders to rectify a
          national debut using Medicare fraud as the target.

     When the FBI raided my office, took charts, and withdrew $400,000 from my clinic and personal bank accounts, thereby crippling the medical practice and forcing me to downsize (placing numerous employees on the unemployment rolls), their unstated explanation was that I was guilty of Medicare fraud.
     Medicare, in response, placed my office on what's called a "100% review."  This meant that Medicare wouldn't pay my office for patient services until it had reviewed paper copies of every single medical service billed.  Since Medicare is backlogged, it has taken up to a year for its coding specialists to get around to reviewing my clinic's documentation for patient services.  (What happened to the law stating that Medicare must pay within 45 days?)
     Starting in January 2012, payments from Medicare began to trickle in.  The payments are for services from last year.  Each month, the payments get bigger, showing that Medicare coding specialists do not find evidence to support allegations of medical fraud in my clinic.  While it is aggravating that it takes up to a year for me to get paid for services, including interventions that require an initial outlay of money on my part (e.g., for IV supplies, crutches, medications), it is reassuring to see that even when my clinic records are subjected to the most extensive, nitpicking, professional analysis--a 100% review is just that--there is no evidence of fraud.  Medicare is paying me, slowly--because it's a painstakingly human process to analyze records--but it is authorizing payment.
     Here's the two-timing problem.  One branch of the government--the prosecutors and FBI--are attempting to indict me for Medicare fraud, have already exacted punishment, and continue to hold me hostage through fear-engendering tactics.  Another branch of the same government--Medicare and its billing and coding experts--has determined, after reviewing every single page of every single record--that there isn't evidence of fraud.   I have not changed the way I practice, or the way I bill:  it is the same has it has been for twelve years, since I first opened a solo clinic.  Therefore, I must assume that my system of providing medical care and billing for it is legitimate, in the eyes of the government.
     What does a person do when one arm of the government says one thing, and the other arm says something completely opposite?  It's schizoid, or else it's hypocritical, and just plain absurd.


  1. Part of the problem is the present administration and the pervasive attitude of the Government having the right to tell people what to do, when to do it, how to do it, and who to do it with. Brilliance is not in compliance with the Stupidity of most of those in Government today, most not all, though the smart ones' can not say always what needs to be said as a result of who would be offended, or perhaps more to the point what group, or agenda would be offended. Common Sense is at an unbelievable lack in the World today, as in many people can not do anything without the computer.

    A Woman, Brilliant, who actually makes a living providing actual care, mental, physical, emotional, as in all around care is a force to be reckoned with, many, perhaps especially men and or groups of men wonder what is it they are doing wrong, as in not able to make a Profit Honestly, they perpetuate their own ignorance choosing to intimidate others, as in a Brilliant Woman. You. Period.

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