FW: Unethical tactics by MCOs- RESPONSES
Randy McFarland
Description
Collection
Title:
FW: Unethical tactics by MCOs- RESPONSES
Creator:
Randy McFarland
Date:
4/19/2006
Text:
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 (separated by a blank line)
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?
If your reply to me comes back undeliverable, please forward that
error message to our IT guy, Bruce.
His E mail is: <mailto:<Email Address Redacted>> <Email Address Redacted>
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 (separated by a blank line)
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?
If your reply to me comes back undeliverable, please forward that
error message to our IT guy, Bruce.
His E mail is: <mailto:<Email Address Redacted>> <Email Address Redacted>
Citation
Randy McFarland, “FW: Unethical tactics by MCOs- RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/226622.
