Responses to Doctor/Provider relationship Part II
Jeremy Sprouse
Description
Collection
Title:
Responses to Doctor/Provider relationship Part II
Creator:
Jeremy Sprouse
Date:
2/12/2015
Text:
-------------------------
Is the other provider Hanger? Wouldn't surprise me if so -> Nope..not
Hanger, although I was told by Hangers past CPO that he filed a complaint
with Medicare about this relationship
---------------------------
There's probably a kick back occurring if they are that strong willed about
their referrals. Nothing will come of any action you take. I wish you luck
but any kind of change that would need to take place won't because there's
much bigger problems then prosthetic referrals. You'll just spin your wheels
and may make your situation worse for your company.
Best scenario is new surgeons come in someday and the philosophy will
change.
--------------------------
I have the same exact problem/situation. I even know for a fact there are
kickbacks and under the table deals happening but no idea how one is to go
about addressing it. Please don't attach my name or comment but am
definitely interested in what the others suggest! Thanks!
------------------------
Why can't the patient change doctors? If this doctor is being featured on
the news for being incompetent, surely the wheels of change are already
turning. What state are you in? Are you a licensure state?SC, non licensure
state
---------------------
Have you considered bring this to the more management level, especially at
the hospital level? They deal with the more legal issues and tend to have a
high understanding of the legal ramifications of this.
In fact I had worked very hard to build a good relationship in a Woundcare
situation and received excellent referrals and followed up with good care
only to have new management step in after a couple years and say that the
Dr. had to refer elsewhere! I even met with them at the physicians request
to see if there was an alternative option. The argument was that specific
referral was illegal...not quite sure that was the real reason but go
figure. I honestly think that my competition complained. I know it had
nothing do do with my level of clinical care for sure! If you can pit
management against the physician, management will win.
Anyway, give it a thought. It sounds like you could potentially have a good
case. If at all possible, I would try to have the patient go to the
management with this case. It would look much better that way!
------------------------
Have the patients complain to Medicare then contact the board of vascular
surgeons. If you complain it may be suicide for any future referrals.
-----------------------
Been there. My experience is that old saying nice guys wind up last , at
least in the business world. Un-ethical conduct may not be illegal. You need
a good attorney and deep pockets for this. Good luck.
---------------------
In my opinion, I would discuss with the patient to see if the patient would
file a complaint with the state insurance commissioner as well as the state
medical board. With the insurance commissioner, by not filling out the
Medicare compliant Rx for your company, there is a de-facto exclusion of the
patient's choice of providers. With the medical board, there is a potential
ethics violation for not providing the total proper care by not signing the
Medicare compliant Rx, there is a lack of proper care by making the patient
financially responsible and not having the doctor fulfill proper
requirements, which this same doctor does for other patients (going to the
other provider). Have each individual patient file a complaint, and then
when they pile up, the insurance commissioner/medical board should have more
basis to act.
However, you as a business owner need to show that your Medicare compliant
Rx is reasonable and justified. This is where the physical therapy notes
showing functional level are required.
I personally would build your case with certain patients, go to the therapy
and make sure the notes are in order, before filing a complaint.
You will have a harder time with a provider referring to only one facility.
The MD can support this too many ways. The key is to create an issue with
the individual patients who dislike this. It also does not sound like you
have any proof or systematic example of a stark or anti-kickback violation.
-----------------------
Have the patients file written complaints with detailed documentation.You
can guide them with forms, etc., but it is best if complaints are from the
patient - not a provider.
Patients are allowed to choose providers.
----------------------
Yes please do complain and ask your patients to do so also. Your patients
need to call the phone number on the back of their Medicare card, and we
give out a list of Congressmen with names, phone numbers, faxes and anything
else we think of that might help.
How about a couple of names and numbers:
Erika Williams Provider relations 803 763 6851
and Dick Whitten no phone, but e-mail <mailto:<Email Address Redacted>>
<Email Address Redacted> he is over the prosthetic part of medicare.
--------------------
I had this same problem
Kickbacks to the dr?
Who knows.
---------------------
Medicare doesn't care about the dilemma you are in BUT if what you saying is
true about treating language to patient, I would gather all your complaints
and bring to the hospital administration and your states insurance board
and physician board. Its one thing if he doesn't want to refer to your
office but if he is restrict patient care in any way that by telling patient
what you wrote about or refuse signing papwork, certainly that's a
violation.
----------------------
I am so sorry to hear about this! That is rediculous. I have a similar
situation but boy, it isn't that bad by a long shot! I would absolutely get
as many patient letters as possible and file a complaint to Medicare.
----------------------
Yes
Yes
Yes
No!
---------------------
1. contact medicare report the physician, and report the suspicion of
kickbacks by the O&P facility 2. Most importantly, have your attorney send a
letter to the physician on behalf of the patient 3. if nothing works, take
that patients story to the media
---------------------
You should do very little to nothing. Your patient should notify the
state board of Medicine and file a complaint. Then contact his insurance,
explain about the prosthesis causing the sore and the resulting bills they
get to pay AND what the Dr said; if you go anywhere else I will make sure
your insurance will not buy your legs.
They might give him permission to get another Dr or go out of network if he
is the only game in town so to speak. Your patient cannot like this Dr after
that.
My .02 and glad I closed my practice after 19 years.
-------------------
I am quite sorry to hear of your situation. We had a situation with some
parallels (not nearly as severe) a couple of years ago involving a physician
refusing to sign paperwork that was necessary for us to get paid or the
patient reimbursed (his NP wrote the script). We complained to the state who
did investigate and the doctor signed the paperwork. I wish you the best
with this and I would love to know how this comes out.
-----------------------
Hi Jeremy, I don't have much advise for you but wanted to let you know your
situation is not an isolated one. Where I practiced ( notice past tense
verbiage there) we have a very large orthopedic group that has branched out
into neuro, vascular, physiatry, and rehab. ( probably 20 physicians now)
and a vascular group with 6 Doc's. They, everyone of the Doc's, practically
insist their patients go to the nationally established provider in town,
some Doc's are much more vocal then others. This P&O provider provides
terrible service and product, I heard complaints daily about their lack of
professionalism, yet no other P&O provider ( 2 others in town) can get a
referral from this group. The ONLY thing that makes any sense is some sort
of kickback going on. Yet I found no way to launch an investigation. If you
find an avenue to pursue please let me know. Between audits and this group
of doc's I was forced to close my practice of 12 years, and to say I'm angry
is an understatement.
Interesting that your vascular physician also runs the wound care clinic,
sounds like a perfect relationship he has with his chosen P&O provider. Let
me guess this bilateral patient is in a hyperbaric chamber at least 1 a week
at $1000 a visit attempting to heal wounds, right?
Please don't post this reply, and good luck to you.
---------------------------
Wow Jeremy! You certainly know how to ask the difficult questions.
Here is my quick suggestion: go to the medicare website and file a
complaint if you feel like it. It'll fall onto sort of deaf ears.
BETTER YET: Have each complaining patient file one on their own. They
cannot expect you to file for them as that wouldn't get any attention at
all. You weren't there to see/hear/or feel what happened, so medicare needs
first-hand information.
investigate the owner and partner relationship of this doctor's preferred
practice and see if they are referring their patients to a practice they own
part of. This would be a violation of the stark law. That you can turn in.
Or, you will then know to move along elsewhere in your marketing plan.
Now, I think the patient who says they were threatened with denial of a
limb may have misquoted the doctor. However, if they didn't, that is a
grave situation indeed. Have them complain to your state's dept of health
or the dept that licenses doctors and medicare. Again, they all need
first-hand information.
A word to the wise, though: if you complain about this medical practice
there could be repercussions. Make sure your glass house is spotless before
you throw any stones.
I hope you find a way to work around this. Obviously, patients cannot be
required to use one O&P place (or one Rx place, or one X-Ray place, etc.)
over another. They can complain loudly and firmly to medicare and other
insurers. They can also say those two little words that doctors HATE to
hear: You're fired!
What they cannot do, is give you secondhand information and expect you to
solve problems that they are unwilling to address. I wish for all your
sakes you could do it for them.
Finally, go see the practice manager and inquire in a business-like fashion
what it takes to get a referral from the practice. Perhaps the other O&P
shop gets the referrals because they asked for them. If the answer is
'nothing, we're not changing our ways' then you have no reason to worry
about marketing to them further. If one field is closed, you hunt
elsewhere, right?
FYI, in a blatant ad here, my classes business principals for credentialed
professionals are on www.oandpedu.com and you receive CEU's for taking
them. There are some great ideas for building your practice in these
classes. If, after you have taken them, you need additional help, don't
hesitate to call.
Let me know how it turns out,
-------------------------------
Is the other provider Hanger? Wouldn't surprise me if so -> Nope..not
Hanger, although I was told by Hangers past CPO that he filed a complaint
with Medicare about this relationship
---------------------------
There's probably a kick back occurring if they are that strong willed about
their referrals. Nothing will come of any action you take. I wish you luck
but any kind of change that would need to take place won't because there's
much bigger problems then prosthetic referrals. You'll just spin your wheels
and may make your situation worse for your company.
Best scenario is new surgeons come in someday and the philosophy will
change.
--------------------------
I have the same exact problem/situation. I even know for a fact there are
kickbacks and under the table deals happening but no idea how one is to go
about addressing it. Please don't attach my name or comment but am
definitely interested in what the others suggest! Thanks!
------------------------
Why can't the patient change doctors? If this doctor is being featured on
the news for being incompetent, surely the wheels of change are already
turning. What state are you in? Are you a licensure state?SC, non licensure
state
---------------------
Have you considered bring this to the more management level, especially at
the hospital level? They deal with the more legal issues and tend to have a
high understanding of the legal ramifications of this.
In fact I had worked very hard to build a good relationship in a Woundcare
situation and received excellent referrals and followed up with good care
only to have new management step in after a couple years and say that the
Dr. had to refer elsewhere! I even met with them at the physicians request
to see if there was an alternative option. The argument was that specific
referral was illegal...not quite sure that was the real reason but go
figure. I honestly think that my competition complained. I know it had
nothing do do with my level of clinical care for sure! If you can pit
management against the physician, management will win.
Anyway, give it a thought. It sounds like you could potentially have a good
case. If at all possible, I would try to have the patient go to the
management with this case. It would look much better that way!
------------------------
Have the patients complain to Medicare then contact the board of vascular
surgeons. If you complain it may be suicide for any future referrals.
-----------------------
Been there. My experience is that old saying nice guys wind up last , at
least in the business world. Un-ethical conduct may not be illegal. You need
a good attorney and deep pockets for this. Good luck.
---------------------
In my opinion, I would discuss with the patient to see if the patient would
file a complaint with the state insurance commissioner as well as the state
medical board. With the insurance commissioner, by not filling out the
Medicare compliant Rx for your company, there is a de-facto exclusion of the
patient's choice of providers. With the medical board, there is a potential
ethics violation for not providing the total proper care by not signing the
Medicare compliant Rx, there is a lack of proper care by making the patient
financially responsible and not having the doctor fulfill proper
requirements, which this same doctor does for other patients (going to the
other provider). Have each individual patient file a complaint, and then
when they pile up, the insurance commissioner/medical board should have more
basis to act.
However, you as a business owner need to show that your Medicare compliant
Rx is reasonable and justified. This is where the physical therapy notes
showing functional level are required.
I personally would build your case with certain patients, go to the therapy
and make sure the notes are in order, before filing a complaint.
You will have a harder time with a provider referring to only one facility.
The MD can support this too many ways. The key is to create an issue with
the individual patients who dislike this. It also does not sound like you
have any proof or systematic example of a stark or anti-kickback violation.
-----------------------
Have the patients file written complaints with detailed documentation.You
can guide them with forms, etc., but it is best if complaints are from the
patient - not a provider.
Patients are allowed to choose providers.
----------------------
Yes please do complain and ask your patients to do so also. Your patients
need to call the phone number on the back of their Medicare card, and we
give out a list of Congressmen with names, phone numbers, faxes and anything
else we think of that might help.
How about a couple of names and numbers:
Erika Williams Provider relations 803 763 6851
and Dick Whitten no phone, but e-mail <mailto:<Email Address Redacted>>
<Email Address Redacted> he is over the prosthetic part of medicare.
--------------------
I had this same problem
Kickbacks to the dr?
Who knows.
---------------------
Medicare doesn't care about the dilemma you are in BUT if what you saying is
true about treating language to patient, I would gather all your complaints
and bring to the hospital administration and your states insurance board
and physician board. Its one thing if he doesn't want to refer to your
office but if he is restrict patient care in any way that by telling patient
what you wrote about or refuse signing papwork, certainly that's a
violation.
----------------------
I am so sorry to hear about this! That is rediculous. I have a similar
situation but boy, it isn't that bad by a long shot! I would absolutely get
as many patient letters as possible and file a complaint to Medicare.
----------------------
Yes
Yes
Yes
No!
---------------------
1. contact medicare report the physician, and report the suspicion of
kickbacks by the O&P facility 2. Most importantly, have your attorney send a
letter to the physician on behalf of the patient 3. if nothing works, take
that patients story to the media
---------------------
You should do very little to nothing. Your patient should notify the
state board of Medicine and file a complaint. Then contact his insurance,
explain about the prosthesis causing the sore and the resulting bills they
get to pay AND what the Dr said; if you go anywhere else I will make sure
your insurance will not buy your legs.
They might give him permission to get another Dr or go out of network if he
is the only game in town so to speak. Your patient cannot like this Dr after
that.
My .02 and glad I closed my practice after 19 years.
-------------------
I am quite sorry to hear of your situation. We had a situation with some
parallels (not nearly as severe) a couple of years ago involving a physician
refusing to sign paperwork that was necessary for us to get paid or the
patient reimbursed (his NP wrote the script). We complained to the state who
did investigate and the doctor signed the paperwork. I wish you the best
with this and I would love to know how this comes out.
-----------------------
Hi Jeremy, I don't have much advise for you but wanted to let you know your
situation is not an isolated one. Where I practiced ( notice past tense
verbiage there) we have a very large orthopedic group that has branched out
into neuro, vascular, physiatry, and rehab. ( probably 20 physicians now)
and a vascular group with 6 Doc's. They, everyone of the Doc's, practically
insist their patients go to the nationally established provider in town,
some Doc's are much more vocal then others. This P&O provider provides
terrible service and product, I heard complaints daily about their lack of
professionalism, yet no other P&O provider ( 2 others in town) can get a
referral from this group. The ONLY thing that makes any sense is some sort
of kickback going on. Yet I found no way to launch an investigation. If you
find an avenue to pursue please let me know. Between audits and this group
of doc's I was forced to close my practice of 12 years, and to say I'm angry
is an understatement.
Interesting that your vascular physician also runs the wound care clinic,
sounds like a perfect relationship he has with his chosen P&O provider. Let
me guess this bilateral patient is in a hyperbaric chamber at least 1 a week
at $1000 a visit attempting to heal wounds, right?
Please don't post this reply, and good luck to you.
---------------------------
Wow Jeremy! You certainly know how to ask the difficult questions.
Here is my quick suggestion: go to the medicare website and file a
complaint if you feel like it. It'll fall onto sort of deaf ears.
BETTER YET: Have each complaining patient file one on their own. They
cannot expect you to file for them as that wouldn't get any attention at
all. You weren't there to see/hear/or feel what happened, so medicare needs
first-hand information.
investigate the owner and partner relationship of this doctor's preferred
practice and see if they are referring their patients to a practice they own
part of. This would be a violation of the stark law. That you can turn in.
Or, you will then know to move along elsewhere in your marketing plan.
Now, I think the patient who says they were threatened with denial of a
limb may have misquoted the doctor. However, if they didn't, that is a
grave situation indeed. Have them complain to your state's dept of health
or the dept that licenses doctors and medicare. Again, they all need
first-hand information.
A word to the wise, though: if you complain about this medical practice
there could be repercussions. Make sure your glass house is spotless before
you throw any stones.
I hope you find a way to work around this. Obviously, patients cannot be
required to use one O&P place (or one Rx place, or one X-Ray place, etc.)
over another. They can complain loudly and firmly to medicare and other
insurers. They can also say those two little words that doctors HATE to
hear: You're fired!
What they cannot do, is give you secondhand information and expect you to
solve problems that they are unwilling to address. I wish for all your
sakes you could do it for them.
Finally, go see the practice manager and inquire in a business-like fashion
what it takes to get a referral from the practice. Perhaps the other O&P
shop gets the referrals because they asked for them. If the answer is
'nothing, we're not changing our ways' then you have no reason to worry
about marketing to them further. If one field is closed, you hunt
elsewhere, right?
FYI, in a blatant ad here, my classes business principals for credentialed
professionals are on www.oandpedu.com and you receive CEU's for taking
them. There are some great ideas for building your practice in these
classes. If, after you have taken them, you need additional help, don't
hesitate to call.
Let me know how it turns out,
-------------------------------
Citation
Jeremy Sprouse, “Responses to Doctor/Provider relationship Part II,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237119.
