Re: FW: Unethical tactics by MCOs- RESPONSES
Kim L. Ruhl CPO
Description
Collection
Title:
Re: FW: Unethical tactics by MCOs- RESPONSES
Creator:
Kim L. Ruhl CPO
Date:
4/19/2006
Text:
Randy and List Members,
Are you surprised by the glaring lack of responses posted below? I used to be, but I began to realize why there are so few these days who seem worried by this MCO's tactics. The reaction you are seeing is the classic example of the cat who ate the canary.
Have you ever observed someone who is feeling a little more than guilty? They usually keep their head down, avoid eye contact, and maintain a strained and conspicuous silence. Is there any doubt as to why that is? Does the absence of commentary, and the obvious lack of moral outrage reveal a similar strategy for avoiding attraction of unwanted attention? Is the silence being maintained, a vain hope that perpetrators won't betray themselves, by opening their mouths and tipping their hand in an unnatural display of behavior?
Folks until we finally take responsibility and clean up our end of the profession, I believe we really won't have much of a reason to expect justice to show up anytime soon.
Sincerely,
Kim L. Ruhl CPO
ORIGINAL POST
Be wary of MCOs or insurance companies trying to work us against each other above and beyond what's fair. I know of one case where a competitor of mine was told that my company and a national competitor were offering prosthetic services for a patient at well below Medicaid fees, which was totally untrue.
I can't talk specifics, but it's clear that while we are expected to be ethical in our dealings, what's to prevent insurance companies from using such tactics to grind us down on our fees?
Randy McFarland, CPO
Fullerton, CA
RESPONSES
Thanks for your post on this subject! It is a very good point, although I have not yet had a carrier use this tactic to pit me against a competing O&P provider.
Regardless, the continued ratcheting down of O&P reimbursements is strangling our profession to a death and I see little being done to address this issue. I have been told by one of our national O&P practice insurers that they have lost numerous accounts over the past year because of practices that have simply had to close there doors!
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They have been doing that here in NY for years. Home Depot looks better and better. I just say no and when they get to the Doc. 9 out of 10 times the Pt. doesn't get what the Doc expected.
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Yes Randy this is true. I learned this back in 1994 in the Chicago area. The only thing you can do is keep them accountable in any way you can and that means even outing them to the media. This was one of the tactics I used to get a fair shake. As it turned out only the promise was needed. Ladies and Gentlemen the game is rigged and we are on the outside! Say what you will that is the short of the story.
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This is an all too common tactic or variation thereof. This insurance provider is blatantly lying and misrepresenting the facts. They are using them like a burglar's crowbar to leverage open locked doors and help themselves to profit that is not legally theirs. In short this is called fraud and extortion. Not only is this company willing to fraud their insured membership, but they are attempting to extort from their contract providers as well. I am convinced this violates several laws on the books somewhere in California.
Randy it is incumbent upon you to report this suspected or alleged criminal activity to your State Insurance Commissioner and the California Attorney General. It is a clear cut example of fraud and extortion and needs to be addressed for everyone's sake.
While I find your story highly disturbing, there is an even sadder commentary taking place. Government agencies such as Medicare and Medicaid are turning to similar tactics. Desperate to balance budget shortfalls, they too are turning to extortion and fraud. In light of today's economy, they are beginning to view these criminal actions as legitimate accounting tools for balancing runaway budgets. Where does it all end? If you can't trust government officials to abide by the law and play fairly, then just who can you trust these days?
-----------------------
Well that has been the long standing rule they have an open playing field with no rule's. Insurance company's can talk rates and technique between themselves. But we can't. My rates for employees insurance just went up 300 per. I tried to increase my contract 3% and was denied?
Are you surprised by the glaring lack of responses posted below? I used to be, but I began to realize why there are so few these days who seem worried by this MCO's tactics. The reaction you are seeing is the classic example of the cat who ate the canary.
Have you ever observed someone who is feeling a little more than guilty? They usually keep their head down, avoid eye contact, and maintain a strained and conspicuous silence. Is there any doubt as to why that is? Does the absence of commentary, and the obvious lack of moral outrage reveal a similar strategy for avoiding attraction of unwanted attention? Is the silence being maintained, a vain hope that perpetrators won't betray themselves, by opening their mouths and tipping their hand in an unnatural display of behavior?
Folks until we finally take responsibility and clean up our end of the profession, I believe we really won't have much of a reason to expect justice to show up anytime soon.
Sincerely,
Kim L. Ruhl CPO
ORIGINAL POST
Be wary of MCOs or insurance companies trying to work us against each other above and beyond what's fair. I know of one case where a competitor of mine was told that my company and a national competitor were offering prosthetic services for a patient at well below Medicaid fees, which was totally untrue.
I can't talk specifics, but it's clear that while we are expected to be ethical in our dealings, what's to prevent insurance companies from using such tactics to grind us down on our fees?
Randy McFarland, CPO
Fullerton, CA
RESPONSES
Thanks for your post on this subject! It is a very good point, although I have not yet had a carrier use this tactic to pit me against a competing O&P provider.
Regardless, the continued ratcheting down of O&P reimbursements is strangling our profession to a death and I see little being done to address this issue. I have been told by one of our national O&P practice insurers that they have lost numerous accounts over the past year because of practices that have simply had to close there doors!
-----------------------
They have been doing that here in NY for years. Home Depot looks better and better. I just say no and when they get to the Doc. 9 out of 10 times the Pt. doesn't get what the Doc expected.
-----------------------
Yes Randy this is true. I learned this back in 1994 in the Chicago area. The only thing you can do is keep them accountable in any way you can and that means even outing them to the media. This was one of the tactics I used to get a fair shake. As it turned out only the promise was needed. Ladies and Gentlemen the game is rigged and we are on the outside! Say what you will that is the short of the story.
-----------------------
This is an all too common tactic or variation thereof. This insurance provider is blatantly lying and misrepresenting the facts. They are using them like a burglar's crowbar to leverage open locked doors and help themselves to profit that is not legally theirs. In short this is called fraud and extortion. Not only is this company willing to fraud their insured membership, but they are attempting to extort from their contract providers as well. I am convinced this violates several laws on the books somewhere in California.
Randy it is incumbent upon you to report this suspected or alleged criminal activity to your State Insurance Commissioner and the California Attorney General. It is a clear cut example of fraud and extortion and needs to be addressed for everyone's sake.
While I find your story highly disturbing, there is an even sadder commentary taking place. Government agencies such as Medicare and Medicaid are turning to similar tactics. Desperate to balance budget shortfalls, they too are turning to extortion and fraud. In light of today's economy, they are beginning to view these criminal actions as legitimate accounting tools for balancing runaway budgets. Where does it all end? If you can't trust government officials to abide by the law and play fairly, then just who can you trust these days?
-----------------------
Well that has been the long standing rule they have an open playing field with no rule's. Insurance company's can talk rates and technique between themselves. But we can't. My rates for employees insurance just went up 300 per. I tried to increase my contract 3% and was denied?
Citation
Kim L. Ruhl CPO, “Re: FW: Unethical tactics by MCOs- RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/226618.
