Ethical Question - Summary of Responses - #1
David Hendricks
Description
Collection
Title:
Ethical Question - Summary of Responses - #1
Creator:
David Hendricks
Date:
3/22/2006
Text:
Dear Orthotic-Prosthetic Colleagues:
Here is my original question:
I had lunch the other day with an orthotist friend who asked my opinion on an ethical question. He's been approached by a company who wants to use his credentials (he's a BOC orthotist, not currently practicing). They are in a state without licensure. They have people who have no credentials, but they have been doing AFOs, CROW walkers, Richie Braces, Arizona-type AFOs, custom shoes, etc. for years. They do this work for Medicare and some insurance companies, but other insurances demand orthotic credentials.
My response to him was that letting a company he doesn't actually work for use his credentials is unethical for the simple reason that it's a lie. He is allowing the company to pretend to these insurers that he is in their employ, when he is not. They are telling the insurer that a credentialed person will be seeing their patients, when that is not true.
His answer was that it's not a matter of patient care. The uncredentialed but competent people already at the facility currently see patients for Medicare and others. It's just a way to get past insurers who have placed impediments in the way of someone becoming a provider in order so they don't have to pay for claims they should be paying for.
He made a valid counter-argument and I promised him I would present this dilemma on the listserv - of which he is not a member - for comment.
What do you think? Has anyone out there has faced a similar decision? Is there any ethical (and legal) way for my friend to derive income from credentials which are current and valid but not being used? Assuming that the facility's use of his credentials is an illegitimate end run around the insurance company's illegitimate block, does that make it ethically OK?
'Thanks, in advance, for your comments.
I'll post responses, but allow me to summarize. Basically, everyone agreed, without exception, that what my friend has been asked to do is an exceptionally bad idea. The responses mostly had one of these reasons:
1. It's unethical because you would be lying.
2. It's immoral because you would be leading the patient to believe they will get more qualified service than they actually will.
3. It's illegal because you would be contracting with the insurance under false pretenses.
4. It's fraud, for the above reasons.
5. It's a really, really bad idea.
6. This is an excellent argument for licensure.
7. You would be asking to be sued for something you had no control over, if something went wrong.
8. Credentials you have earned are not a commodity you can sell.
9. This is so far across the ethical line that my friend shouldn't trust a company who would even ask about it.
Several replies were well written, well reasoned, and too complex to reduce to a single sentence, so I think it is wise to include all responses. In the interests of professionalism, I have left out a few responses that were so poorly written as to be uninteligible, and I have omitted a few flames as well. That said, here are the responses:
||
Hi David I think your first response is correct - end of story. Is this company unable to get at least one of their uncredentialed but competent individuals through a BOC exam???? Come on.......... Anyway, hope life is treating you well Regards Arthur
||
David: I agree with your initial assessment. I also think these kinds of questions are more likely to come up more often because of the argument your friend offered. I still think it is unethical and I think your friend should stay away from it. But you know your friend may pass and someone who doesn't even seek counsel from another professional may bite on the opportunity without
considering the ethics of the situation. How do we stop this train once it leaves the station? Bob
||
David, if the company has a contract with any of the insurance companies then this not a matter of ethics, it is a matter of fraud on the part of the company! For either an ABC or a BOC credentialed individual, this is unethical. If it were a licensed state it would be fraud and illegal on the part of the individual. Your friend need to turn this company into Medicare and/or the State Insurance Department or at the very least he should run the other way. Terry
||
What good are ANY credentials if they can be rented out to whomever we wish. Such activity is unethical, fraudulent and sleazy. The insurance company is doing the right thing in respecting and recognizing the credentials. While these providers may in fact be experientially qualified - they need to hunker down and get their own credentials. My hats off to the insurance companies that enforce this standard. Of additional note, the qualified practitioner that rents out his credentials is exposing him/herself to liability claims if these providers render services under his/her credential and a problem, negligence or liability claim arises. Ralph W. Nobbe, CPO
||
No, it is not ethical. Your points are valid. It does not surprise me that a BOC credentialed individual would not admit this was unethical. It only reinforces the reputation the BOC has worked so hard to establish since its inception. It sounds par for the course. James Mc Coy, C.P., L.P., FAAOP
||
Dear David, I would go one step further. It is not just a lie it is FRAUD. These people are not competent if they are not deemed so by passing at least the minimum requirements to be credentialed. I have designed and built a few buildings including my office. Can't I hang a shingle stating that I'm an architect. If your friend is knowingly letting them use his credentials he is committing fraud. The company is committing fraud using his credentials. I wonder why they don't get credentialed . Mike Kiser C.O.
||
Absolutely he should not let his credentials be used. Can you imagine if a pilot, MD, CPA, judge or anyone else made the argument that they personally decided someone was competent to fly a plane, etc and therefore was allowed to fly using their license. I could crash a plane, treat my injuries, write off the med expenses on my taxes, and then find myself not guilty of
anything. Beautiful.
||
As I think about this it make me realize that this is why certain states are going after licensure. Ours is in the process of initiating the process (PA). We need to keep companies like the one that wants to use this gentleman's title out of the market place. Especially after I went and educated myself at the best school offering O&P training (Northwestern), so I could work with and bill insurances after I provided quality service to their customers (clients, patients). I don't feel that this is ethical at all. Respectfully Submitted, Paul De La Torre CPO, C.Ped
||
Hi David. NO! Only if he checks every item, this is why we are going down the tubes. It is so easy to get BOC credentials, why don't the people getting paid for the items spend the extra effort to get their credentials? John G. Russell Jr. CPO
||
Since the profession of O&P in unregulated states is self-policed, meaning BOC and ABC rely on the patients and peer network to help them maintain the highest standards, here is one patient's perspective and from a Listserve colleague !
Both ABC/BOC allegedly have active committees that responds to and evaluates all complaints against ABC/BOC credentialed individuals. In my humble opinion ,your example you posted below is indeed unethical but sadly not illegal in states when certification is only a optional requirement and a license is not required. ABC has stated that their Cannon of Ethics do not apply under these circumstances. Neither does BOC if BOC certification is not required to practice in that particular state. This is a common occurrence and circumvents the qualified credentialed provider necessity which is only optional in 40 states. I have high regard for most ABC/BOC credentialed providers and the Academy members, so please don't misinterpret my comments as a method to cause friction, nor sabotage or divide the integrity of ABC/BOC (or the integrity of a ABC accredited facility ) but rather a message to a resource to further protect patients receiving these services. Contrary to belief, if BOC were to report on this specific incident to their membership, they would be sending a message and acted on it and BOC is indeed disclosing and enforcing their own Cannon Of Ethics, it would further reinforce to everyone that do provide some oversight and functioning as it was meant to. In the present controversial O&P reimbursement environment, its important that leaders of the O&P community project to third party payers, lawmakers and the general public, particularly within unlicensed states, that ABC/BOC
is providing oversight of its members and accredited facilities to better ensure and maintain the highest standards in the profession. I think it is also imperative to the current and future credibility for both BOC/ABC, to be recognized as a legitimate professional certification credentialing associations, actively enforce their own Cannons of Ethics particularly in a unregulated state where a patient's only other recourse is the Consumer Affairs Department under the Department of Agriculture within
that state. It further substantiates the need for all legitimate providers of comprehensive O&P for beating the regulation drum and adding some credibility to the profession of O&P it so desperately needs to survive and be respected. Unfortunately the thinking often aligned to unethical VS illegal is that if its not illegal its not unethical ! Perhaps ABC and BOC leadership can respond ? Tony Barr
||
David, Of course you are right and he is wrong. You might want to ask him how he will explain this to an attorney, judge, and jury if by chance the company using his credentials is sued by a patient. Maurice
||
-- more responses to follow --
David Hendricks, CPO, FAAOP
<Email Address Redacted>
HOPE Orthopedic
Here is my original question:
I had lunch the other day with an orthotist friend who asked my opinion on an ethical question. He's been approached by a company who wants to use his credentials (he's a BOC orthotist, not currently practicing). They are in a state without licensure. They have people who have no credentials, but they have been doing AFOs, CROW walkers, Richie Braces, Arizona-type AFOs, custom shoes, etc. for years. They do this work for Medicare and some insurance companies, but other insurances demand orthotic credentials.
My response to him was that letting a company he doesn't actually work for use his credentials is unethical for the simple reason that it's a lie. He is allowing the company to pretend to these insurers that he is in their employ, when he is not. They are telling the insurer that a credentialed person will be seeing their patients, when that is not true.
His answer was that it's not a matter of patient care. The uncredentialed but competent people already at the facility currently see patients for Medicare and others. It's just a way to get past insurers who have placed impediments in the way of someone becoming a provider in order so they don't have to pay for claims they should be paying for.
He made a valid counter-argument and I promised him I would present this dilemma on the listserv - of which he is not a member - for comment.
What do you think? Has anyone out there has faced a similar decision? Is there any ethical (and legal) way for my friend to derive income from credentials which are current and valid but not being used? Assuming that the facility's use of his credentials is an illegitimate end run around the insurance company's illegitimate block, does that make it ethically OK?
'Thanks, in advance, for your comments.
I'll post responses, but allow me to summarize. Basically, everyone agreed, without exception, that what my friend has been asked to do is an exceptionally bad idea. The responses mostly had one of these reasons:
1. It's unethical because you would be lying.
2. It's immoral because you would be leading the patient to believe they will get more qualified service than they actually will.
3. It's illegal because you would be contracting with the insurance under false pretenses.
4. It's fraud, for the above reasons.
5. It's a really, really bad idea.
6. This is an excellent argument for licensure.
7. You would be asking to be sued for something you had no control over, if something went wrong.
8. Credentials you have earned are not a commodity you can sell.
9. This is so far across the ethical line that my friend shouldn't trust a company who would even ask about it.
Several replies were well written, well reasoned, and too complex to reduce to a single sentence, so I think it is wise to include all responses. In the interests of professionalism, I have left out a few responses that were so poorly written as to be uninteligible, and I have omitted a few flames as well. That said, here are the responses:
||
Hi David I think your first response is correct - end of story. Is this company unable to get at least one of their uncredentialed but competent individuals through a BOC exam???? Come on.......... Anyway, hope life is treating you well Regards Arthur
||
David: I agree with your initial assessment. I also think these kinds of questions are more likely to come up more often because of the argument your friend offered. I still think it is unethical and I think your friend should stay away from it. But you know your friend may pass and someone who doesn't even seek counsel from another professional may bite on the opportunity without
considering the ethics of the situation. How do we stop this train once it leaves the station? Bob
||
David, if the company has a contract with any of the insurance companies then this not a matter of ethics, it is a matter of fraud on the part of the company! For either an ABC or a BOC credentialed individual, this is unethical. If it were a licensed state it would be fraud and illegal on the part of the individual. Your friend need to turn this company into Medicare and/or the State Insurance Department or at the very least he should run the other way. Terry
||
What good are ANY credentials if they can be rented out to whomever we wish. Such activity is unethical, fraudulent and sleazy. The insurance company is doing the right thing in respecting and recognizing the credentials. While these providers may in fact be experientially qualified - they need to hunker down and get their own credentials. My hats off to the insurance companies that enforce this standard. Of additional note, the qualified practitioner that rents out his credentials is exposing him/herself to liability claims if these providers render services under his/her credential and a problem, negligence or liability claim arises. Ralph W. Nobbe, CPO
||
No, it is not ethical. Your points are valid. It does not surprise me that a BOC credentialed individual would not admit this was unethical. It only reinforces the reputation the BOC has worked so hard to establish since its inception. It sounds par for the course. James Mc Coy, C.P., L.P., FAAOP
||
Dear David, I would go one step further. It is not just a lie it is FRAUD. These people are not competent if they are not deemed so by passing at least the minimum requirements to be credentialed. I have designed and built a few buildings including my office. Can't I hang a shingle stating that I'm an architect. If your friend is knowingly letting them use his credentials he is committing fraud. The company is committing fraud using his credentials. I wonder why they don't get credentialed . Mike Kiser C.O.
||
Absolutely he should not let his credentials be used. Can you imagine if a pilot, MD, CPA, judge or anyone else made the argument that they personally decided someone was competent to fly a plane, etc and therefore was allowed to fly using their license. I could crash a plane, treat my injuries, write off the med expenses on my taxes, and then find myself not guilty of
anything. Beautiful.
||
As I think about this it make me realize that this is why certain states are going after licensure. Ours is in the process of initiating the process (PA). We need to keep companies like the one that wants to use this gentleman's title out of the market place. Especially after I went and educated myself at the best school offering O&P training (Northwestern), so I could work with and bill insurances after I provided quality service to their customers (clients, patients). I don't feel that this is ethical at all. Respectfully Submitted, Paul De La Torre CPO, C.Ped
||
Hi David. NO! Only if he checks every item, this is why we are going down the tubes. It is so easy to get BOC credentials, why don't the people getting paid for the items spend the extra effort to get their credentials? John G. Russell Jr. CPO
||
Since the profession of O&P in unregulated states is self-policed, meaning BOC and ABC rely on the patients and peer network to help them maintain the highest standards, here is one patient's perspective and from a Listserve colleague !
Both ABC/BOC allegedly have active committees that responds to and evaluates all complaints against ABC/BOC credentialed individuals. In my humble opinion ,your example you posted below is indeed unethical but sadly not illegal in states when certification is only a optional requirement and a license is not required. ABC has stated that their Cannon of Ethics do not apply under these circumstances. Neither does BOC if BOC certification is not required to practice in that particular state. This is a common occurrence and circumvents the qualified credentialed provider necessity which is only optional in 40 states. I have high regard for most ABC/BOC credentialed providers and the Academy members, so please don't misinterpret my comments as a method to cause friction, nor sabotage or divide the integrity of ABC/BOC (or the integrity of a ABC accredited facility ) but rather a message to a resource to further protect patients receiving these services. Contrary to belief, if BOC were to report on this specific incident to their membership, they would be sending a message and acted on it and BOC is indeed disclosing and enforcing their own Cannon Of Ethics, it would further reinforce to everyone that do provide some oversight and functioning as it was meant to. In the present controversial O&P reimbursement environment, its important that leaders of the O&P community project to third party payers, lawmakers and the general public, particularly within unlicensed states, that ABC/BOC
is providing oversight of its members and accredited facilities to better ensure and maintain the highest standards in the profession. I think it is also imperative to the current and future credibility for both BOC/ABC, to be recognized as a legitimate professional certification credentialing associations, actively enforce their own Cannons of Ethics particularly in a unregulated state where a patient's only other recourse is the Consumer Affairs Department under the Department of Agriculture within
that state. It further substantiates the need for all legitimate providers of comprehensive O&P for beating the regulation drum and adding some credibility to the profession of O&P it so desperately needs to survive and be respected. Unfortunately the thinking often aligned to unethical VS illegal is that if its not illegal its not unethical ! Perhaps ABC and BOC leadership can respond ? Tony Barr
||
David, Of course you are right and he is wrong. You might want to ask him how he will explain this to an attorney, judge, and jury if by chance the company using his credentials is sued by a patient. Maurice
||
-- more responses to follow --
David Hendricks, CPO, FAAOP
<Email Address Redacted>
HOPE Orthopedic
Citation
David Hendricks, “Ethical Question - Summary of Responses - #1,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/226339.
