Ethical Question - Summary of Responses - #2
David Hendricks
Description
Collection
Title:
Ethical Question - Summary of Responses - #2
Creator:
David Hendricks
Date:
3/22/2006
Text:
unethical?, depends on BOC's cannons. Fraud? POSITIVELY! Jim Fenton, LPO
||
David, I would say that it is unethical. He's providing no function for this company but allowing them to use his name and credentials. If there is a suit over something that has his name on it-He's liable! All the best, Robert L. Rhodes, MPA, CO
||
The problem is that the rules by the insurance company to have some formal education by the people who see the patients are justified since they are to pay for professional services; which are in this case medical services. The demands may vary whether the services provided require a weekend certification such as a supplier's course for one particular product; ie: Diabetic Shoes. The demands may increase equal to the needs when it requires a ABC certificate to fit a spinal jacket for spinal instability due to cancer, or a above knee prosthesis following uncontrolled diabetics infection or vascular disease. These treatments for the patient demand a formal knowledge base. The insurance company has an obligation to pay for legitimate services, and make sure the services are deliverd to the patient. I guess we could say they are a gatekeeper in their own way. So my answer is that I do not think it is legitimate for a company to use his certification to falsley represent that correct care is being dispensed just because this certified individual is on staff. Being on staff is not a guarantee of quality assurance, especially in a busy practice with multiple practitioners. Multiply this misleading reference when there are satellite offices in the city or other states. A person can only be in one place at one time. I believe that is why licensure is so necessary, but I don't want to get off the subject. I would say that this individual should not let someone use their credentials if he is not going to be supervising the clinical care. Richard Feldman,CPO
||
If this BOC Orthotist allows anyone to use his credentials without physically seeing the patient and being on staff, he will open himself to possible litigation and fraud. When medicare learns of this, they will audit records and probably request return of all payments for each patient treated under your credentials. The other insurance providers will follow suit upon learning of this behavior. If providers require credentialed practitioners, then they all should be credentialed, especially on documented charting. If not, the lawyers will have a feast!!! Johnny Morgan, II CP, LPO
||
The first thing that comes to mind is insurance fraud.You know....plain old thievery. These people are not qualified to do the work in the eyes of the insurance companies and the insurance companies can legally set their standards , in this case, as I admit ,as low as they could possibly get, to determine who is qualified to practice. If these guys even had a hint of legitimacy they would have their certiciation from someone , at least it requires some continuing education. After all, how difficult is it to get BOC certification? ...........take a video of someone Breathing? Secondly when did your friend become the judge of who is qualified and competent to practice O and P without training? Do you think his BOC certification also qualifies him to determine this? Gee, why have a certification organizations, education , training or licensure? We could just ask your friend if a person is qualified or not. Just think of how much money that would save everyone, we could drop licensure and certifications, we could just call your friend and it would be settled.Words cannot describe how absurd and stupid this thought process is. How can your friend even have a thought of legitimacy on these issues? I question your friends common sense, ethics, education, credentials and judgement, there is no moral compass there just pretzel logic. Ron
||
the answer is simple and I am not going to even get into legal ramifications of this practice. the provider is accepting payment and stating they are in agreemennt with the providers rules that enable them to receive reimbursment (having the device fit by
a certified practitioner). They are not following the rules they agreed to. They are in fault. I don't see how you can see it any
other way. They have the option to be a provider to this insurance company, no one is forcing them. and by the way, if their staff is so competant, why don't they get certified by the BOC. Jon Yanke, CPO
||
Mr. Hendricks, The situation you described, in my opinion, is flat out FRAUD! That practitioner should have his credentials revoked; retired or not! How can anyone with any respect for our profession participate in muddying the waters any further? We in O&P have enough trouble gaining the respect we deserve as part of the medical profession. We ARE NOT SALESMEN. Medicare and other insurance carriers do not need anymore reasons to reduce reimbursement for our devices and services because they believe any tom, dick or harry can be qualified providers. I continue to be flabbergasted everyday by the overwhelming volume of people providing O&P services in this country w/o ANY education. How can it be okay to have someone with no anatomical education decide on and then fit a device? What a crock! Rick Milen, B.S., CPO, PTA
||
Your initial response is correct. It is a lie, to the insurers and to the patients. If the people are competent, let them apply for the proper credentials. It's my bet they are paid less and therefore the business is more profitable. Insurers have rules and regulations for reasons, although some may be a little difficult to understand sometimes, they are usually in the benefit of the patient. Your friends' counter-argument doesn't cut mustard. My opinion is that not only is it unethical but most likely illegal.
||
NO! NO! NO! This should not even be an issue. It is, indeed, unethical to lend out one's credentials and should be considered fraudulent. No amount of rationalizing can justify this and one should be wary of an individual or company who even thinks to ask this of an individual. Steven Fries, LPO
||
Hey David: Nice to see you in Chicago. Consider first that perhaps the insurance companies are making a legitimate attempt to improve the quality of care their customers receive. We are all suspicious of insurance companies motives and it usually does have to do with money. Stop and think for a minute, aren't products provided by uncredentialed individuals usually cheaper? So the insurance company is not saving money by requiring credentialed providers. Bottom line the patients are better served by a certified practitioner who has at least a basic level of education and the consumer has some recourse through professional channels. I look at it this way, when I get my hair cut I look for the person's license as evidence that they have a basic level of training on how to cut hair. Why shouldn't we expect the same of someone fitting a brace meant to correct or protect? After all, a bad haircut will eventually grow back :-) Jack Richmond, CFo
||
We are allowed to do consulting work, but in my humble opinion anyone who is signing off on items they have not fit or even observed is in danger of legally being in jeopardy if not ethically against our canons.
Does your friend want to sit on the stand and say he did not see the patient, but his credentials are on the HCFA 1500, or similar. If your friend was involved in training the competent personnel, then he would have a stronger argument that his credential and experience was being applied. This has been the conundrum with the Assistant program. What can they do
without the direct observation of the supervising credentialed practitioner? This grey area or interpretation may move to the courtroom where explanations without action carry little weight. Paul Oswald CPO
||
Any credentials he may have were conferred to him as a person, they are not a commodity he can sell. How would he feel if he found out his surgeon was using another person's credentials and was not really an M.D. Even if all of the surgeon's patients lived it is still illegal and immoral. When he gets too old to drive is he also going to sell his driver's license to someone who does not want to take the time to study the driving test and pass? After all he won't be using that license any more either. His argument is a cop out. He is on a slippery slope dealing with a company willing to buy credentials. Will he be willing to take the next step when asked to give a little something back to doctors for referrals, after all the insurance companies are probably only requiring prescriptions to cut down on how many people can get serviced. Your friend must think his credentials are worth something if he plans on selling them. Tell him to keep them valuable by keeping ethical and legal.
The only way I see for them to bill for his credentials is if he does the work! Glen Waldner, LPO, CPO
||
HE CAN WORK PART TIME OR BY APPT WHEN THE PATIENTS HE IS RESPONSIBLE FOR ARE THERE ---IT COULD BE A FEW HOURS A DAY OR WEEK ----ANYTHING ELSE IS FRAUD AND AGAINST THE LAW-----MEDICARE SHOULD BE ASHAMED OF THEMSELVES FOR LETTING BUSINESS PROVIDE THIS SERVICE----------------LAST YEAR MEDICAID CAME INTO MY OFFICE OF 30 YEARS OF PROVIDING SERVICES AND TOOK MY MEDICAID ID # AWAY FOR 3 MONTHS(((((((((REASON )))))))BECAUSE I DIDN'T HAVE THE HOURS OF OPERATION ON MY DOOR AND THIS WAS IN VIOLATION -------ALTHOUGH IT DID SAY (((((((( BY APPOINTMENT ONLY )))))) .... MY OFFICE IS IN A PROFESSIONAL OFFICE AND NOT SEEN FROM THE STREET-------INT THIS BUSINESS GREAT???????????????
||
Why do you consider the payor's requirement of a credentialed provider as illegitement? What your friend wants to do is aiding and abetting the commission of fraud. Bill Arrowood, CP
||
ethics aside, your friend would be opening himself up for potential lawsuits and/or criminal prosecution if anything should happen (patient injury, illegal billing, falsifying documents,etc.) even if he didn't do it. any company who is asking someone to do something unethical is probably skirting around other ethical/legal issues, as well. it's one thing to get accused of
something you did, but to put yourself in a position to be accused of something you didn't do just because your name is attached... i don't feel it's worth risking losing your livelihood over. just my opinion. sara guzman, PT
||
Yes...I have ran into this years ago in my local area. A practitioner from 250 miles away used his name and photograph at a facility so they could become certified and bill for prosthetic services. Several letters to ABC and AOPA resulted in absolutely nothing! This well known practitioner has been outspoken about our profession to the extent he speaks with fork tongue! Frustrating and sad is only the beginning........ You need to make this person aware that he is liable in a court of law for any legal action that may arise from a patient who takes action against this company. They will take him for every dime to include the company owners who will point the finger at him if legal actions results. STUPID for even associating with a company like that and really STUPID for opening himself up for legal action indirectly.
||
Thank you, all of you who responded. So many responses came in that I'll consider the matter closed and I won't post any more responses, unless something new, different and incredibly inciteful comes in.
Regards to all.
David Hendricks, CPO, FAAOP
<Email Address Redacted>
HOPE Orthopedic
||
David, I would say that it is unethical. He's providing no function for this company but allowing them to use his name and credentials. If there is a suit over something that has his name on it-He's liable! All the best, Robert L. Rhodes, MPA, CO
||
The problem is that the rules by the insurance company to have some formal education by the people who see the patients are justified since they are to pay for professional services; which are in this case medical services. The demands may vary whether the services provided require a weekend certification such as a supplier's course for one particular product; ie: Diabetic Shoes. The demands may increase equal to the needs when it requires a ABC certificate to fit a spinal jacket for spinal instability due to cancer, or a above knee prosthesis following uncontrolled diabetics infection or vascular disease. These treatments for the patient demand a formal knowledge base. The insurance company has an obligation to pay for legitimate services, and make sure the services are deliverd to the patient. I guess we could say they are a gatekeeper in their own way. So my answer is that I do not think it is legitimate for a company to use his certification to falsley represent that correct care is being dispensed just because this certified individual is on staff. Being on staff is not a guarantee of quality assurance, especially in a busy practice with multiple practitioners. Multiply this misleading reference when there are satellite offices in the city or other states. A person can only be in one place at one time. I believe that is why licensure is so necessary, but I don't want to get off the subject. I would say that this individual should not let someone use their credentials if he is not going to be supervising the clinical care. Richard Feldman,CPO
||
If this BOC Orthotist allows anyone to use his credentials without physically seeing the patient and being on staff, he will open himself to possible litigation and fraud. When medicare learns of this, they will audit records and probably request return of all payments for each patient treated under your credentials. The other insurance providers will follow suit upon learning of this behavior. If providers require credentialed practitioners, then they all should be credentialed, especially on documented charting. If not, the lawyers will have a feast!!! Johnny Morgan, II CP, LPO
||
The first thing that comes to mind is insurance fraud.You know....plain old thievery. These people are not qualified to do the work in the eyes of the insurance companies and the insurance companies can legally set their standards , in this case, as I admit ,as low as they could possibly get, to determine who is qualified to practice. If these guys even had a hint of legitimacy they would have their certiciation from someone , at least it requires some continuing education. After all, how difficult is it to get BOC certification? ...........take a video of someone Breathing? Secondly when did your friend become the judge of who is qualified and competent to practice O and P without training? Do you think his BOC certification also qualifies him to determine this? Gee, why have a certification organizations, education , training or licensure? We could just ask your friend if a person is qualified or not. Just think of how much money that would save everyone, we could drop licensure and certifications, we could just call your friend and it would be settled.Words cannot describe how absurd and stupid this thought process is. How can your friend even have a thought of legitimacy on these issues? I question your friends common sense, ethics, education, credentials and judgement, there is no moral compass there just pretzel logic. Ron
||
the answer is simple and I am not going to even get into legal ramifications of this practice. the provider is accepting payment and stating they are in agreemennt with the providers rules that enable them to receive reimbursment (having the device fit by
a certified practitioner). They are not following the rules they agreed to. They are in fault. I don't see how you can see it any
other way. They have the option to be a provider to this insurance company, no one is forcing them. and by the way, if their staff is so competant, why don't they get certified by the BOC. Jon Yanke, CPO
||
Mr. Hendricks, The situation you described, in my opinion, is flat out FRAUD! That practitioner should have his credentials revoked; retired or not! How can anyone with any respect for our profession participate in muddying the waters any further? We in O&P have enough trouble gaining the respect we deserve as part of the medical profession. We ARE NOT SALESMEN. Medicare and other insurance carriers do not need anymore reasons to reduce reimbursement for our devices and services because they believe any tom, dick or harry can be qualified providers. I continue to be flabbergasted everyday by the overwhelming volume of people providing O&P services in this country w/o ANY education. How can it be okay to have someone with no anatomical education decide on and then fit a device? What a crock! Rick Milen, B.S., CPO, PTA
||
Your initial response is correct. It is a lie, to the insurers and to the patients. If the people are competent, let them apply for the proper credentials. It's my bet they are paid less and therefore the business is more profitable. Insurers have rules and regulations for reasons, although some may be a little difficult to understand sometimes, they are usually in the benefit of the patient. Your friends' counter-argument doesn't cut mustard. My opinion is that not only is it unethical but most likely illegal.
||
NO! NO! NO! This should not even be an issue. It is, indeed, unethical to lend out one's credentials and should be considered fraudulent. No amount of rationalizing can justify this and one should be wary of an individual or company who even thinks to ask this of an individual. Steven Fries, LPO
||
Hey David: Nice to see you in Chicago. Consider first that perhaps the insurance companies are making a legitimate attempt to improve the quality of care their customers receive. We are all suspicious of insurance companies motives and it usually does have to do with money. Stop and think for a minute, aren't products provided by uncredentialed individuals usually cheaper? So the insurance company is not saving money by requiring credentialed providers. Bottom line the patients are better served by a certified practitioner who has at least a basic level of education and the consumer has some recourse through professional channels. I look at it this way, when I get my hair cut I look for the person's license as evidence that they have a basic level of training on how to cut hair. Why shouldn't we expect the same of someone fitting a brace meant to correct or protect? After all, a bad haircut will eventually grow back :-) Jack Richmond, CFo
||
We are allowed to do consulting work, but in my humble opinion anyone who is signing off on items they have not fit or even observed is in danger of legally being in jeopardy if not ethically against our canons.
Does your friend want to sit on the stand and say he did not see the patient, but his credentials are on the HCFA 1500, or similar. If your friend was involved in training the competent personnel, then he would have a stronger argument that his credential and experience was being applied. This has been the conundrum with the Assistant program. What can they do
without the direct observation of the supervising credentialed practitioner? This grey area or interpretation may move to the courtroom where explanations without action carry little weight. Paul Oswald CPO
||
Any credentials he may have were conferred to him as a person, they are not a commodity he can sell. How would he feel if he found out his surgeon was using another person's credentials and was not really an M.D. Even if all of the surgeon's patients lived it is still illegal and immoral. When he gets too old to drive is he also going to sell his driver's license to someone who does not want to take the time to study the driving test and pass? After all he won't be using that license any more either. His argument is a cop out. He is on a slippery slope dealing with a company willing to buy credentials. Will he be willing to take the next step when asked to give a little something back to doctors for referrals, after all the insurance companies are probably only requiring prescriptions to cut down on how many people can get serviced. Your friend must think his credentials are worth something if he plans on selling them. Tell him to keep them valuable by keeping ethical and legal.
The only way I see for them to bill for his credentials is if he does the work! Glen Waldner, LPO, CPO
||
HE CAN WORK PART TIME OR BY APPT WHEN THE PATIENTS HE IS RESPONSIBLE FOR ARE THERE ---IT COULD BE A FEW HOURS A DAY OR WEEK ----ANYTHING ELSE IS FRAUD AND AGAINST THE LAW-----MEDICARE SHOULD BE ASHAMED OF THEMSELVES FOR LETTING BUSINESS PROVIDE THIS SERVICE----------------LAST YEAR MEDICAID CAME INTO MY OFFICE OF 30 YEARS OF PROVIDING SERVICES AND TOOK MY MEDICAID ID # AWAY FOR 3 MONTHS(((((((((REASON )))))))BECAUSE I DIDN'T HAVE THE HOURS OF OPERATION ON MY DOOR AND THIS WAS IN VIOLATION -------ALTHOUGH IT DID SAY (((((((( BY APPOINTMENT ONLY )))))) .... MY OFFICE IS IN A PROFESSIONAL OFFICE AND NOT SEEN FROM THE STREET-------INT THIS BUSINESS GREAT???????????????
||
Why do you consider the payor's requirement of a credentialed provider as illegitement? What your friend wants to do is aiding and abetting the commission of fraud. Bill Arrowood, CP
||
ethics aside, your friend would be opening himself up for potential lawsuits and/or criminal prosecution if anything should happen (patient injury, illegal billing, falsifying documents,etc.) even if he didn't do it. any company who is asking someone to do something unethical is probably skirting around other ethical/legal issues, as well. it's one thing to get accused of
something you did, but to put yourself in a position to be accused of something you didn't do just because your name is attached... i don't feel it's worth risking losing your livelihood over. just my opinion. sara guzman, PT
||
Yes...I have ran into this years ago in my local area. A practitioner from 250 miles away used his name and photograph at a facility so they could become certified and bill for prosthetic services. Several letters to ABC and AOPA resulted in absolutely nothing! This well known practitioner has been outspoken about our profession to the extent he speaks with fork tongue! Frustrating and sad is only the beginning........ You need to make this person aware that he is liable in a court of law for any legal action that may arise from a patient who takes action against this company. They will take him for every dime to include the company owners who will point the finger at him if legal actions results. STUPID for even associating with a company like that and really STUPID for opening himself up for legal action indirectly.
||
Thank you, all of you who responded. So many responses came in that I'll consider the matter closed and I won't post any more responses, unless something new, different and incredibly inciteful comes in.
Regards to all.
David Hendricks, CPO, FAAOP
<Email Address Redacted>
HOPE Orthopedic
Citation
David Hendricks, “Ethical Question - Summary of Responses - #2,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/226342.
