Sunday, November 18, 2012

My 200th Post: A Synopsis

     Once upon a time I was a happy doctor.
     I traveled from exam room to exam room every day, marveling at the variation among humans and their adaptability, studying medical journals and texts at night, taking care of my children, tending a garden, and falling into the deep, exhausted sleep of personal fulfillment every night.  I loved my work.
     Then came coding.  When I started my own medical clinic, I thought how wonderful it was to own a business, making decisions--without bureaucratic holdups--for the good of patients and employees, expanding the number of services we offered, and carving out a little niche in a rural area.  Patients were happy.  We did a lot of good.  My integrity meant everything, because I understood it to be the foundation of a successful business.
     But this was not just any business.  I couldn't simply offer a product or service, the way a grocery stores or steam-cleaning businesses do, and get paid in cash when the job was done.  I had to code for what I did, using a new abstruse, almost hieroglyphic language, and I had to describe in painstaking detail every conversation I had, and the reasons for the time I spent with patients, and the subject matter, and I had to provide explanations the government thought were acceptable, and I couldn't do anything without the government's approval, which was always given or withheld until long after the medical visit, after the treatment.
     Everyone knows that if you wait until after a person or organization receives a service, the chances of getting paid for that service go way down.  Isn't that why hotels switched, long ago, to a system whereby guests pay in advance for their stay, not after?  And gas stations--which used to allow clients to fill their tanks first, then walk into the little store and pay--now requiring cash or a credit card up front?  They stopped because people ripped them off.
     The government, it turns out, is no different.  It rips off doctors all the time, via Medicare and Medicaid, by refusing to pay for medical services for patients, claiming that it does so to save taxpayers money, and using a host of excuses that have to do with coding errors, documentation inadequacies, and decisions about what should and shouldn't have been done for patients--excuses that come from a place high in the sky, where money matters more than care, and where more money is spent than ever should be, in the long run, because proper care isn't paid for up front.  The government has taught other insurance companies, like Blue Cross, United Healthcare, and Aetna, its tactics.  Now everyone has joined in the game of auditing doctors, and routinely denying them payment.
     Sometimes the government rips off doctors in far bigger ways.  It places something like classified ads for special high-paying jobs in all its mail communications with Medicare and Medicaid recipients:  the job of Whistleblower.  "If you think your doctor made a mistake, and you want to make a lot of money without losing a dime, call us..." the ad goes. "Call us immediately."
     Whether there are grounds for such reports or not, the fact that an individual has filed a report gives the government immediate license to break and enter.  Its agents tell a judge that they have sufficient reason to suspect fraud, and the judge gives them permission--contained in sealed affidavits that no one else can see--to take a clinic's charts, supplies and money.  It can take everything, and keep it.
     The government isn't looking for wrongdoing, particularly--it's looking for money.  Its agents are selective about which medical practices it raids:  there has to be sufficient money to take back, which is a term Medicare uses, and the government uses, and is synonymous with steal.
     One day, thirty or forty FBI agents raided my clinic, terrorizing patients and staff with their stern voices and gun-filled holsters.  They took all the patients' charts, and dozens of brand-new IUD's, and all ninety vials of medicine earmarked for specific patients:  Reclast, Boniva, Synvisc, Orthovisc, Restylene.  They also went to the bank and withdrew the clinic's working assets, as well as all the cash in my personal bank accounts. These bank forfeitures totaled $400,000, which demolished the clinic, at least temporarily.  The banks closed our accounts, fearful they had been dealing with a delinquent.  The local TV station reported the event as though it were one more lurid crime story.
     Patients were not deterred.  They continued to fill the waiting room and ask for medical help.  They were angry, wanted their charts back, and couldn't get answers from the FBI.  But my license and board certification remained intact, and my staff and I mustered the energy to get back to work.  Two weeks after the raid the clinic was on its feet, albeit with a reduced staff, and empty chart-racks, and the mood of shock and horror that can pervade a place after an unjust attack.
     The government's so-called investigation of Colasante Clinic started in June 2010, when a whistleblower, Pat McCullough, filed a report as a way of deflecting attention for her expertly orchestrated takeover, pillage, and destruction of a fully-functioning, solvent clinic in Hawthorne, which she purchased from me, saying she wanted to help people.  Instead, she sold the equipment, misrepresented the clinic's assets as a tactic for borrowing money from banks, and dissolved the business a year later, when there were no more profits to be extracted from it.  She was granted bankruptcy relief shortly thereafter, without much scrutiny, and now waits for her whistleblower suit against me to pay off.   The government seems to have eaten out of her hand.  Of course, it stood to gain, too.
     Now, I am tired in the way people get tired when ignorance, greed and corruption cause harm and win out.  The government has been silent for twenty-nine months.  It has kept its reasons for the raid and take-back secret;  it has influenced Medicare to stop paying for most of my services to patients;  it has kept all the supplies, charts and money that belonged to the clinic.
     Why not?   The government is protected by a bulwark of statutes that were passed into legislation without much public understanding of their implications for doctors and patients, such as the Health Insurance Portability and Improvement Act of 1996, the Medicare Modernization Act of 2003, the Tax Relief and Health Care Act of 2006, and the Patient Protection and Affordable Care Act of 2010. 
     "The government" is just a bunch of flawed people, who need to prove to the American people that they're cracking down on fraud, and they do so by taking money from physicians--who don't have the resources, time, or legal protection conferred by due process to fight back.  In addition, it is advertising its good deeds to the public, as a way, for example, of justifying the FBI's $8 billion budget per year,  that it has "recovered" billions of dollars in money from doctors, who are bad and should not have been paid, and perhaps should be "regulated" even more.
     I am closing my medical clinic on January 31, 2013, having given the requisite 90-day notice to all insurance carriers, having canceled my lease, malpractice insurance, and general office liability coverage, having notified AHCA, CLIA, the licensing board, and all other agencies whose approval to run a clinic and practice medicine took so much work to obtain.  I am closing my medical clinic, not because I can't make a living any more, not because I have been shut down or denied the privilege of practicing medicine, but because I am disgusted.
     I am closing my clinic and discontinuing the practice of medicine exactly when America needs doctors most, to meet the upcoming demand for medical care that will hit the country on January 1st when Obamacare's wide-open promise to provide medical care to all uninsured citizens must be fulfilled.
     I hope my story is not a common one.  Many doctors tell me they are also disgusted with the current state of medicine in this country, and are dropping Medicare, or opting out of doctoring altogether.  Maybe it's not everyone.  Maybe they will wait to see if things improve with the new healthcare plan.  That would be good, but it's not for me.  Good luck, America, I say.  Good luck.

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