Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 " Tell the truth, all the time " You may be better off writing off the balance, choose your battles carefully...-- Pedro Ballester, M.D.Warren, OH Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Maybe he never told her about the diagnosis? I would state (but only to the patient), “you are asking me to lie”. I once had a patient’s life insurance rates increase due to “depression” being on health summary. (was a historical thing, inactive and not on meds) As a favor, I wrote a letter to the company explaining the diagnosis as mild, not interfering with function, never suicidal, etc etc. However, it made no difference to her carrier. SO, I suppose with the patient’s permission, you could offer to write a letter regarding how well he took care of his health. “I can do my best with a letter explaining….but there is no guarantee…” I would not do any such writing if bill has not been paid. Also would consider charging for the effort of writing the letter/records release, etc. People are amazing! Ramona Ramona G. Seidel, MD www.baycrossingfamilymedicine.com Your Bridge to Health NOTE NEW ADDRESS AND PHONE NUMBER: 269 Peninsula Farm Road Suite F Arnold, MD 21012 410 518-9808 From: [mailto: ] On Behalf Of djgalvon Sent: Wednesday, February 11, 2009 10:41 PM To: Subject: bribery for forgery A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to " take diabetes off his record " . She insists he " never was Diabetic " and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show " the truth " ; ie: that he never was Diabetic. How should I respond? (yes, this is for real!) Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Stick to your guns (your accurate diagnosis) and tell the truth (he was diabetic). You can’t alter medical records, anyway. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of djgalvon Sent: Wednesday, February 11, 2009 8:41 PM To: Subject: bribery for forgery A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to " take diabetes off his record " . She insists he " never was Diabetic " and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show " the truth " ; ie: that he never was Diabetic. How should I respond? (yes, this is for real!) Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Dennis,Something similar happened to me recently. I saw a patient for a routine physical. Mid-40s, male. He kept asking for reassurances that the visit would be "free" because his insurance would pay for an annual physical. I told him I couldn't guarantee that the entire visit's cost would be paid for, that it depended on his insurance and how they calculated it. Anyways when I asked if he took any medicines, he named two BP meds. I asked him who prescribed them for him, and he said he gets them from a doctor in the ines, where he is from. His BP was under control so no big deal, but I listed HTN as a diagnosis along with V70.0. I got a call from his mother-in-law later (weird, right?) insisting that I submitted the claim incorrectly because now his insurance says they won't pay for the visit because he has a pre-existing condition. She swears she has known him for 30 years and he has no pre-existing condition. After I get the patient's permission to talk to her, I tell her that he told me he takes BP medication for HTN. She yells over to him while on the phone, "Did you tell the doctor that you take blood pressure medicine?" "No, no. Sometimes", I hear him say in the background. Now he claims that it was all a mistake, that he used to take it but not for the past 12 years. He tells me I need to change the diagnosis code otherwise insurance won't pay for the visit. I tell him that I won't lie and I stand by what I submitted. Later on, I called the insurance company and they said they are holding the claim and told the patient to submit old records from his previous doctors here in the US and in the ines before they will make a decision. Sounds reasonable to me. Needless to say, I don't expect to get paid from either the insurance company or the patient for this visit. It sounds like the wife probably thinks her husband never had DM because he never started on any medication for it. But she probably wouldn't care even if you explained it carefully to her. She just wants it off his record so that he can lower his insurance premium. It's another sad sign of our dysfunctional healthcare system that patients are punished for switching insurance plans and doctors are forced to consider making unethical decisions in order to help patients. I agree with Pedro that you should stick to your principles and write off the charge. Dennis, can you explain how you changed to a retainer practice, what led you to this decision and how much you charge? I sort of did the same thing last year and started charging a mini-retainer fee of $120/year, which I think is low. SetoSouth Pasadena, CAA middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 She does have a point. He lost weight, and no longer has the raised blood sugars as a result of your advice. So unless you do more testing, it appears he is now in a pre-diabetic stage. Do you call those people who develop gestational diabetes diabetics? Or those people who develop diabetes while in ICU, and lose it when whatever stress is resolved? Those rare patients of mine who do exercise, diet and obtain normal HbA1c levels - I tell them they no longer have diabetes. But it will come back if they relapse on the diet and exercise. On Thu, Feb 12, 2009 at 5:16 PM, Eads wrote: > Stick to your guns (your accurate diagnosis) and tell the truth (he was > diabetic). You can't alter medical records, anyway. > -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 I tell them they have diabetes which is diet controlled to normal levels. They are still diabetics and are probably still at risk for complications over nondiabetic population. Diabetes is not curable. I would simply explain that you are unwilling to commit fraud by lying about his medical record and will not jeopardize your license and career for her lower insurance premium. I might mention that you could tell the insurance company that she asked you to commit fraud. I would also explain that it is against the law to alter the medical record and that could also jeopardize your license and career, but you could add a note that she called demanding the diagnosis of DM be removed and then send the records to the insurance company. Of course I am a bit of a harda** and would keep billing for the balance. You have nothing to lose, you have already lost them as patients. Reminds me of the time my patient with a blood sugar of over 300 got mad at me that I wouldn’t sign off on his CDL. Complained of how much money I was costing him because he went and bought his own rig and now I wouldn’t let him drive it. I kept trying to explain that was his problem and if he would take his meds and get his butt into gear lowering his blood sugar to safe levels, I could sign his CDL but I wasn’t going to jeopardize my license over his problem. He should have thought of that before he bought the rig. Nothing is worth the risk of losing our license. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Graham Chiu Sent: Wednesday, February 11, 2009 11:31 PM To: Subject: Re: bribery for forgery She does have a point. He lost weight, and no longer has the raised blood sugars as a result of your advice. So unless you do more testing, it appears he is now in a pre-diabetic stage. Do you call those people who develop gestational diabetes diabetics? Or those people who develop diabetes while in ICU, and lose it when whatever stress is resolved? Those rare patients of mine who do exercise, diet and obtain normal HbA1c levels - I tell them they no longer have diabetes. But it will come back if they relapse on the diet and exercise. On Thu, Feb 12, 2009 at 5:16 PM, Eads wrote: > Stick to your guns (your accurate diagnosis) and tell the truth (he was > diabetic). You can't alter medical records, anyway. > -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Actually, the " insurance people " are amazing.The patient are woman may be appearing unreasonable, but they are reacting to a tough situation.They may not be in that situation if the insurance folks were reasonable. That fact that your letter about the depression didn't change the situation for the other person shows, again, how ridiculous the system is. It's toxic, not just for us, but for the patients too.The patients should pity the doctors and vice versa.TimOn Wed, February 11, 2009 11:01 pm EST, RGMS wrote: Maybe he never told her about thediagnosis? I would state (but only to the patient), “you are askingme to lie”. I once had a patient’s lifeinsurance rates increase due to “depression” being on healthsummary. (was a historical thing, inactive and not on meds) As afavor, I wrote a letter to the company explaining the diagnosis as mild, notinterfering with function, never suicidal, etc etc. However, it made nodifference to her carrier. SO, I suppose with the patient’s permission, you couldoffer to write a letter regarding how well he took care of his health. “Ican do my best with a letter explaining….but there is no guarantee…” I would not do any such writing if bill has not been paid. Also wouldconsider charging for the effort of writing the letter/records release, etc. People are amazing! Ramona Ramona G. Seidel, MD www.baycrossingfamilymedicine.com Your Bridge to Health NOTE NEW ADDRESS AND PHONE NUMBER: 269 Peninsula Farm Road Suite F Arnold, MD 21012 410 518-9808 From: [mailto: ] On Behalf Of djgalvonSent: Wednesday, February 11, 200910:41 PMTo: Subject: bribery for forgery A middle aged obese male patient used to be mypatient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to " take diabetes off his record " . She insists he " never was Diabetic " and they can'tget cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show " the truth " ; ie: that henever was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon ---------------------------------------- Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.---------------------------------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 I am shocked. In my experience the insurance company never looks beyond the first code. If I accidentally bill for a preventative health but code the 401.1 before the V70.0, it will get denied. Did you bill the preventative health code? If it was his “annual physical”, it shouldn’t matter if he has 10 other underlying conditions unless the contract reads “annual physical in a perfectly healthy person only”. Just my opinion. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Seto Sent: Wednesday, February 11, 2009 11:31 PM To: Subject: Re: bribery for forgery Dennis, Something similar happened to me recently. I saw a patient for a routine physical. Mid-40s, male. He kept asking for reassurances that the visit would be " free " because his insurance would pay for an annual physical. I told him I couldn't guarantee that the entire visit's cost would be paid for, that it depended on his insurance and how they calculated it. Anyways when I asked if he took any medicines, he named two BP meds. I asked him who prescribed them for him, and he said he gets them from a doctor in the ines, where he is from. His BP was under control so no big deal, but I listed HTN as a diagnosis along with V70.0. I got a call from his mother-in-law later (weird, right?) insisting that I submitted the claim incorrectly because now his insurance says they won't pay for the visit because he has a pre-existing condition. She swears she has known him for 30 years and he has no pre-existing condition. After I get the patient's permission to talk to her, I tell her that he told me he takes BP medication for HTN. She yells over to him while on the phone, " Did you tell the doctor that you take blood pressure medicine? " " No, no. Sometimes " , I hear him say in the background. Now he claims that it was all a mistake, that he used to take it but not for the past 12 years. He tells me I need to change the diagnosis code otherwise insurance won't pay for the visit. I tell him that I won't lie and I stand by what I submitted. Later on, I called the insurance company and they said they are holding the claim and told the patient to submit old records from his previous doctors here in the US and in the ines before they will make a decision. Sounds reasonable to me. Needless to say, I don't expect to get paid from either the insurance company or the patient for this visit. It sounds like the wife probably thinks her husband never had DM because he never started on any medication for it. But she probably wouldn't care even if you explained it carefully to her. She just wants it off his record so that he can lower his insurance premium. It's another sad sign of our dysfunctional healthcare system that patients are punished for switching insurance plans and doctors are forced to consider making unethical decisions in order to help patients. I agree with Pedro that you should stick to your principles and write off the charge. Dennis, can you explain how you changed to a retainer practice, what led you to this decision and how much you charge? I sort of did the same thing last year and started charging a mini-retainer fee of $120/year, which I think is low. Seto South Pasadena, CA A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to " take diabetes off his record " . She insists he " never was Diabetic " and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show " the truth " ; ie: that he never was Diabetic. How should I respond? (yes, this is for real!) Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Actually that's extortion not bribery. Under Hipaa a patient has a right to examinethe medical record and ask that corrections be made if appropriate. Never take away from but you may add, with the appropriate notation, date time signature... ML RE: bribery for forgery Stick to your guns (your accurate diagnosis) and tell the truth (he was diabetic). You can’t alter medical records, anyway. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of djgalvonSent: Wednesday, February 11, 2009 8:41 PMTo: Subject: bribery for forgery A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Kathy,I coded the visit as a 99386 with ICD9 codes of V70.0 and 401.9. The insurance plan is Anthem PPO. I agree with you that they should still pay but I'm not holding my breath. SetoSouth Pasadena, CA I am shocked. In my experience the insurance company never looks beyond the first code. If I accidentally bill for a preventative health but code the 401.1 before the V70.0, it will get denied. Did you bill the preventative health code? If it was his “annual physical”, it shouldn’t matter if he has 10 other underlying conditions unless the contract reads “annual physical in a perfectly healthy person only”. Just my opinion. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of SetoSent: Wednesday, February 11, 2009 11:31 PMTo: Subject: Re: bribery for forgery Dennis,Something similar happened to me recently. I saw a patient for a routine physical. Mid-40s, male. He kept asking for reassurances that the visit would be "free" because his insurance would pay for an annual physical. I told him I couldn't guarantee that the entire visit's cost would be paid for, that it depended on his insurance and how they calculated it. Anyways when I asked if he took any medicines, he named two BP meds. I asked him who prescribed them for him, and he said he gets them from a doctor in the ines, where he is from. His BP was under control so no big deal, but I listed HTN as a diagnosis along with V70.0. I got a call from his mother-in-law later (weird, right?) insisting that I submitted the claim incorrectly because now his insurance says they won't pay for the visit because he has a pre-existing condition. She swears she has known him for 30 years and he has no pre-existing condition. After I get the patient's permission to talk to her, I tell her that he told me he takes BP medication for HTN. She yells over to him while on the phone, "Did you tell the doctor that you take blood pressure medicine?" "No, no. Sometimes", I hear him say in the background. Now he claims that it was all a mistake, that he used to take it but not for the past 12 years. He tells me I need to change the diagnosis code otherwise insurance won't pay for the visit. I tell him that I won't lie and I stand by what I submitted. Later on, I called the insurance company and they said they are holding the claim and told the patient to submit old records from his previous doctors here in the US and in the ines before they will make a decision. Sounds reasonable to me. Needless to say, I don't expect to get paid from either the insurance company or the patient for this visit. It sounds like the wife probably thinks her husband never had DM because he never started on any medication for it. But she probably wouldn't care even if you explained it carefully to her. She just wants it off his record so that he can lower his insurance premium. It's another sad sign of our dysfunctional healthcare system that patients are punished for switching insurance plans and doctors are forced to consider making unethical decisions in order to help patients. I agree with Pedro that you should stick to your principles and write off the charge. Dennis, can you explain how you changed to a retainer practice, what led you to this decision and how much you charge? I sort of did the same thing last year and started charging a mini-retainer fee of $120/year, which I think is low. SetoSouth Pasadena, CA A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 I am unsure of this. The WHO definition for diabetes is that fasting plasma glucose ™ 7.0mmol/l (126mg/dl) or 2-h plasma glucose ™ 11.1mmol/l (200mg/dl). Now if this patient lost weight, and no longer met these criteria ( we are told blood sugars normalized ) then by definition he no longer has diabetes. Even those with impaired glucose tolerance, over 11 years, there is a 30% chance they revert to normal. Whether diabetes is curable or not is not relevant; the question is does this patient now meet the definition for DM for insurance purposes .. not for treatment. > I tell them they have diabetes which is diet controlled to normal levels. > They are still diabetics and are probably still at risk for complications > over nondiabetic population. Diabetes is not curable. > -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Patient may have become non-diabetic now, but you can not go back and change your previous records.Dont do it.you can take her to court and get her in jail for fraud and bribery etc .......... but probably it would be bad PR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 When patients ask me to do things that are dishonest i tell them I am not willing to commit fraud for them and explain that i could lose my license or worse. Usually they back off.Subject: bribery for forgeryTo: Date: Wednesday, February 11, 2009, 7:40 PM A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!) Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 1) alot of people don't realize that a "physical" is different from addressing a problem. 2) I've had this happen to me -- the "annual physical" has no deductable; the "problem" billing has a deductable. Matt in Western PA RE: bribery for forgery I am shocked. In my experience the insurance company never looks beyond the first code. If I accidentally bill for a preventative health but code the 401.1 before the V70.0, it will get denied. Did you bill the preventative health code? If it was his “annual physical”, it shouldn’t matter if he has 10 other underlying conditions unless the contract reads “annual physical in a perfectly healthy person only”. Just my opinion. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of SetoSent: Wednesday, February 11, 2009 11:31 PMTo: Subject: Re: bribery for forgery Dennis, Something similar happened to me recently. I saw a patient for a routine physical. Mid-40s, male. He kept asking for reassurances that the visit would be "free" because his insurance would pay for an annual physical. I told him I couldn't guarantee that the entire visit's cost would be paid for, that it depended on his insurance and how they calculated it. Anyways when I asked if he took any medicines, he named two BP meds. I asked him who prescribed them for him, and he said he gets them from a doctor in the ines, where he is from. His BP was under control so no big deal, but I listed HTN as a diagnosis along with V70.0. I got a call from his mother-in-law later (weird, right?) insisting that I submitted the claim incorrectly because now his insurance says they won't pay for the visit because he has a pre-existing condition. She swears she has known him for 30 years and he has no pre-existing condition. After I get the patient's permission to talk to her, I tell her that he told me he takes BP medication for HTN. She yells over to him while on the phone, "Did you tell the doctor that you take blood pressure medicine?" "No, no. Sometimes", I hear him say in the background. Now he claims that it was all a mistake, that he used to take it but not for the past 12 years. He tells me I need to change the diagnosis code otherwise insurance won't pay for the visit. I tell him that I won't lie and I stand by what I submitted. Later on, I called the insurance company and they said they are holding the claim and told the patient to submit old records from his previous doctors here in the US and in the ines before they will make a decision. Sounds reasonable to me. Needless to say, I don't expect to get paid from either the insurance company or the patient for this visit. It sounds like the wife probably thinks her husband never had DM because he never started on any medication for it. But she probably wouldn't care even if you explained it carefully to her. She just wants it off his record so that he can lower his insurance premium. It's another sad sign of our dysfunctional healthcare system that patients are punished for switching insurance plans and doctors are forced to consider making unethical decisions in order to help patients. I agree with Pedro that you should stick to your principles and write off the charge. Dennis, can you explain how you changed to a retainer practice, what led you to this decision and how much you charge? I sort of did the same thing last year and started charging a mini-retainer fee of $120/year, which I think is low. Seto South Pasadena, CA A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Tell them that you wont commit fraud, bill them 3 times for their balance due and if they dont pay, send account to a collection agency. Wayne CoghillPractice ManagerMidtown Primary Carewww.doctorcoghill.com To: Sent: Thursday, February 12, 2009 2:08:06 AMSubject: Re: bribery for forgery When patients ask me to do things that are dishonest i tell them I am not willing to commit fraud for them and explain that i could lose my license or worse. Usually they back off. Subject: bribery for forgeryTo: Date: Wednesday, February 11, 2009, 7:40 PM A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 if u addressed a problem, you also needed to code , say, 99213-25. you must use the modifier. Many will pay if you do this, but not all. Wayne CoghillPractice ManagerMidtown Primary Carewww.doctorcoghill.com To: Sent: Wednesday, February 11, 2009 11:57:06 PMSubject: Re: bribery for forgery Kathy, I coded the visit as a 99386 with ICD9 codes of V70.0 and 401.9. The insurance plan is Anthem PPO. I agree with you that they should still pay but I'm not holding my breath. Seto South Pasadena, CA I am shocked. In my experience the insurance company never looks beyond the first code. If I accidentally bill for a preventative health but code the 401.1 before the V70.0, it will get denied. Did you bill the preventative health code? If it was his “annual physical”, it shouldn’t matter if he has 10 other underlying conditions unless the contract reads “annual physical in a perfectly healthy person only”. Just my opinion. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of SetoSent: Wednesday, February 11, 2009 11:31 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] bribery for forgery Dennis, Something similar happened to me recently. I saw a patient for a routine physical. Mid-40s, male. He kept asking for reassurances that the visit would be "free" because his insurance would pay for an annual physical. I told him I couldn't guarantee that the entire visit's cost would be paid for, that it depended on his insurance and how they calculated it. Anyways when I asked if he took any medicines, he named two BP meds. I asked him who prescribed them for him, and he said he gets them from a doctor in the ines, where he is from. His BP was under control so no big deal, but I listed HTN as a diagnosis along with V70.0. I got a call from his mother-in-law later (weird, right?) insisting that I submitted the claim incorrectly because now his insurance says they won't pay for the visit because he has a pre-existing condition. She swears she has known him for 30 years and he has no pre-existing condition. After I get the patient's permission to talk to her, I tell her that he told me he takes BP medication for HTN. She yells over to him while on the phone, "Did you tell the doctor that you take blood pressure medicine?" "No, no. Sometimes", I hear him say in the background. Now he claims that it was all a mistake, that he used to take it but not for the past 12 years. He tells me I need to change the diagnosis code otherwise insurance won't pay for the visit. I tell him that I won't lie and I stand by what I submitted. Later on, I called the insurance company and they said they are holding the claim and told the patient to submit old records from his previous doctors here in the US and in the ines before they will make a decision. Sounds reasonable to me. Needless to say, I don't expect to get paid from either the insurance company or the patient for this visit. It sounds like the wife probably thinks her husband never had DM because he never started on any medication for it. But she probably wouldn't care even if you explained it carefully to her. She just wants it off his record so that he can lower his insurance premium. It's another sad sign of our dysfunctional healthcare system that patients are punished for switching insurance plans and doctors are forced to consider making unethical decisions in order to help patients. I agree with Pedro that you should stick to your principles and write off the charge. Dennis, can you explain how you changed to a retainer practice, what led you to this decision and how much you charge? I sort of did the same thing last year and started charging a mini-retainer fee of $120/year, which I think is low. Seto South Pasadena, CA A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Same here, I only make one statement “do you know it is illegal to ask someone to commit fraud?” And I stand my ground. José From: [mailto: ] On Behalf Of Lonna Larsh Sent: Thursday, February 12, 2009 2:08 AM To: Subject: Re: bribery for forgery When patients ask me to do things that are dishonest i tell them I am not willing to commit fraud for them and explain that i could lose my license or worse. Usually they back off. Subject: bribery for forgery To: Date: Wednesday, February 11, 2009, 7:40 PM A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to " take diabetes off his record " . She insists he " never was Diabetic " and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show " the truth " ; ie: that he never was Diabetic. How should I respond? (yes, this is for real!) Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Except if he has individual insurance and onthe application he said he didn't have any prwexistings, he applied under fraudulent pretencesand the insurance co has the right to increase his premiums or deny him insurance altogether.It sounds to me that he lied on his app; nota good one to keep on the panel, IMO. P.Sent from my iPhone I am shocked. In my experience the insurance company never looks beyond the first code. If I accidentally bill for a preventative health but code the 401.1 before the V70.0, it will get denied. Did you bill the preventative health code? If it was his “annual physicalâ€, it shouldn’t matter if he has 10 other underlying conditions unless the contract reads “annual physical in a perfectly healthy person onlyâ€. Just my opinion. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Seto Sent: Wednesday, February 11, 2009 11:31 PM To: Subject: Re: bribery for forgery Dennis, Something similar happened to me recently. I saw a patient for a routine physical. Mid-40s, male. He kept asking for reassurances that the visit would be "free" because his insurance would pay for an annual physical. I told him I couldn't guarantee that the entire visit's cost would be paid for, that it depended on his insurance and how they calculated it. Anyways when I asked if he took any medicines, he named two BP meds. I asked him who prescribed them for him, and he said he gets them from a doctor in the ines, where he is from. His BP was under control so no big deal, but I listed HTN as a diagnosis along with V70.0. I got a call from his mother-in-law later (weird, right?) insisting that I submitted the claim incorrectly because now his insurance says they won't pay for the visit because he has a pre-existing condition. She swears she has known him for 30 years and he has no pre-existing condition. After I get the patient's permission to talk to her, I tell her that he told me he takes BP medication for HTN. She yells over to him while on the phone, "Did you tell the doctor that you take blood pressure medicine?" "No, no. Sometimes", I hear him say in the background. Now he claims that it was all a mistake, that he used to take it but not for the past 12 years. He tells me I need to change the diagnosis code otherwise insurance won't pay for the visit. I tell him that I won't lie and I stand by what I submitted. Later on, I called the insurance company and they said they are holding the claim and told the patient to submit old records from his previous doctors here in the US and in the ines before they will make a decision. Sounds reasonable to me. Needless to say, I don't expect to get paid from either the insurance company or the patient for this visit. It sounds like the wife probably thinks her husband never had DM because he never started on any medication for it. But she probably wouldn't care even if you explained it carefully to her. She just wants it off his record so that he can lower his insurance premium. It's another sad sign of our dysfunctional healthcare system that patients are punished for switching insurance plans and doctors are forced to consider making unethical decisions in order to help patients. I agree with Pedro that you should stick to your principles and write off the charge. Dennis, can you explain how you changed to a retainer practice, what led you to this decision and how much you charge? I sort of did the same thing last year and started charging a mini-retainer fee of $120/year, which I think is low. Seto South Pasadena, CA A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!) Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009  If anyone is interested, you can see what the insurance companies have on you by ordering your own record on the Medical Information Bureau www.mib.com ML Re: bribery for forgery Except if he has individual insurance and on the application he said he didn't have any prw existings, he applied under fraudulent pretences and the insurance co has the right to increase his premiums or deny him insurance altogether. It sounds to me that he lied on his app; not a good one to keep on the panel, IMO. P.Sent from my iPhone I am shocked. In my experience the insurance company never looks beyond the first code. If I accidentally bill for a preventative health but code the 401.1 before the V70.0, it will get denied. Did you bill the preventative health code? If it was his “annual physicalâ€, it shouldn’t matter if he has 10 other underlying conditions unless the contract reads “annual physical in a perfectly healthy person onlyâ€. Just my opinion. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of SetoSent: Wednesday, February 11, 2009 11:31 PMTo: Subject: Re: bribery for forgery Dennis, Something similar happened to me recently. I saw a patient for a routine physical. Mid-40s, male. He kept asking for reassurances that the visit would be "free" because his insurance would pay for an annual physical. I told him I couldn't guarantee that the entire visit's cost would be paid for, that it depended on his insurance and how they calculated it. Anyways when I asked if he took any medicines, he named two BP meds. I asked him who prescribed them for him, and he said he gets them from a doctor in the ines, where he is from. His BP was under control so no big deal, but I listed HTN as a diagnosis along with V70.0. I got a call from his mother-in-law later (weird, right?) insisting that I submitted the claim incorrectly because now his insurance says they won't pay for the visit because he has a pre-existing condition. She swears she has known him for 30 years and he has no pre-existing condition. After I get the patient's permission to talk to her, I tell her that he told me he takes BP medication for HTN. She yells over to him while on the phone, "Did you tell the doctor that you take blood pressure medicine?" "No, no. Sometimes", I hear him say in the background. Now he claims that it was all a mistake, that he used to take it but not for the past 12 years. He tells me I need to change the diagnosis code otherwise insurance won't pay for the visit. I tell him that I won't lie and I stand by what I submitted. Later on, I called the insurance company and they said they are holding the claim and told the patient to submit old records from his previous doctors here in the US and in the ines before they will make a decision. Sounds reasonable to me. Needless to say, I don't expect to get paid from either the insurance company or the patient for this visit. It sounds like the wife probably thinks her husband never had DM because he never started on any medication for it. But she probably wouldn't care even if you explained it carefully to her. She just wants it off his record so that he can lower his insurance premium. It's another sad sign of our dysfunctional healthcare system that patients are punished for switching insurance plans and doctors are forced to consider making unethical decisions in order to help patients. I agree with Pedro that you should stick to your principles and write off the charge. Dennis, can you explain how you changed to a retainer practice, what led you to this decision and how much you charge? I sort of did the same thing last year and started charging a mini-retainer fee of $120/year, which I think is low. Seto South Pasadena, CA A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 With the truth. There is no other way to respomd. "Dear Mr. X, your payment to me dos not depend on release og medical records. Pay up or go to collection". And forward the diabetes records To: Sent: Wednesday, February 11, 2009 10:40:42 PMSubject: bribery for forgery A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 no need to even reply. send to collections. you did not do anything wrong. (i know things like this happen for real - i fight cynicism everyday) grace > > With the truth. There is no other way to respomd. > " Dear Mr. X, your payment to me dos not depend on release og medical records. Pay up or go to collection " . And forward the diabetes records > > > > > ________________________________ > > To: > Sent: Wednesday, February 11, 2009 10:40:42 PM > Subject: bribery for forgery > > > A middle aged obese male patient used to be my patient. I diagnosed > Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He > was motivated to lose weight, to exercise and change his diet. His > sugars dropped into the normal range. He moved on to another doc when I > changed to retainer practice last year. > Grateful patient, good result, right? > > No way. His wife has called me a number of times to " take diabetes off > his record " . She insists he " never was Diabetic " and they can't get > cheap insurance now. I recently sent out patient statements and he has > modest balance to pay. She has stated that she will only pay my bill > when i alter my medical records to show " the truth " ; ie: that he never > was Diabetic. > > How should I respond? > > (yes, this is for real!) > Dennis Galvon > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Dear Dennis, I have had patients ask me to alter the records. I tell them "Surely you would not want me to lie. I am a Christian and could not do that and still face Jesus." Then they shut up. One or two appologized after they thought about it. That approach is right up there with my statement to the residency's rotation surgeon who was bitching and moaning about his reimbursment from medicare for a colecystectomy "Oh, well," I said, "We have to do a little bit of this for Jesus." That also shut him up, but from then on he said whenever we had a Medicare patient "So, Joanne, here's one we do for Jesus!" Which I much preferred to his previous..."Damn them, I am just wasting my time here...." Actually, I am more of a pan-diest, but most of these idiots do think of themselves as Christian, and I like to bring them to my spiritual home in the most efficient way. It is useless to talk to a venal person about ethics and service. Joanne in Drain, Oregon. Subject: bribery for forgeryTo: Date: Wednesday, February 11, 2009, 7:40 PM A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 So, Joanne, you're a liar already so you should have no problems Or, were you lying when you said this ... hmm... tricky. > Dear Dennis, > > I have had patients ask me to alter the records. I tell them " Surely > you would not want me to lie. I am a Christian and could not do that and > still face Jesus. " Then they shut up. One or two appologized after they > thought about it. <cut vas here> > Actually, I am more of a pan-diest, but most of these idiots do think of > themselves as Christian, and I like to bring them to my spiritual home in > the most efficient way. It is useless to talk to a venal person about > ethics and service. > > Joanne in Drain, Oregon. > -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Graham, I have no problems with Jesus or Christianity. And I would, indeed, have problems facing Jesus if I lied. In my opinion, we need all the spirituality we can get to survive in this world. And witnessing that is good for us. Of course, my real point is that most people in our culture really would not lie if they thought about their value system when they start. When I draw them back with a reminder, they see themselves and change their minds. This religious statement action on my part is really an act of faith in the people themselves. Again, in my opinion, as a society we need to find ways to insist gently that people act ethically; and I prefer to do it in a way that does not make them defensive or angry. Joanne> Dear Dennis,>> I have had patients ask me to alter the records. I tell them "Surely> you would not want me to lie. I am a Christian and could not do that and> still face Jesus." Then they shut up. One or two appologized after they> thought about it.<cut vas here>> Actually, I am more of a pan-diest, but most of these idiots do think of> themselves as Christian, and I like to bring them to my spiritual home in> the most efficient way. It is useless to talk to a venal person about> ethics and service.>> Joanne in Drain, Oregon.>-- Graham Chiuhttp://www.synapsed irect.comSynapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2009 Report Share Posted February 12, 2009 Well, it's Darwin's 200th birthday anniversary celebrations so I'd rather not talk religion today. I don't recall lying for patients .. but bending the truth a little .... I might have done that in the past. And I know my colleagues have done this. Eg. to get the government to fund a biologic in this country, they have to have rheumatoid arthritis. I know of colleagues who have reclassified a patient with psoriasis as having rheumatoid so that they can get the funding ... But back to specifics. In this case, the patient's wife has asked that the record be altered so that it be shown he never had DM. Well, I wouldn't do that. But it might be argued that he no longer has DM based upon current criteria ( if of course the data we have is correct ). Then others here say that once you have DM, you never lose it. So, which is correct? Was the original diagnosis wrong? Is it wrong for her to ask that the medical records be corrected? This is not the same situation as if the patient still had their glucose intolerance. > Graham, > I have no problems with Jesus or Christianity. And I would, indeed, > have problems facing Jesus if I lied. In my opinion, we need all the > spirituality we can get to survive in this world. And witnessing that is > good for us. > Of course, my real point is that most people in our culture really would > not lie if they thought about their value system when they start. When I > draw them back with a reminder, they see themselves and change their minds. > This religious statement action on my part is really an act of faith in the > people themselves. Again, in my opinion, as a society we need to find ways > to insist gently that people act ethically; and I prefer to do it in a way > that does not make them defensive or angry. > Joanne > > > >> Dear Dennis, >> >> I have had patients ask me to alter the records. I tell them " Surely >> you would not want me to lie. I am a Christian and could not do that and >> still face Jesus. " Then they shut up. One or two appologized after they >> thought about it. > > <cut vas here> > >> Actually, I am more of a pan-diest, but most of these idiots do think of >> themselves as Christian, and I like to bring them to my spiritual home in >> the most efficient way. It is useless to talk to a venal person about >> ethics and service. >> >> Joanne in Drain, Oregon. >> > > -- > Graham Chiu > http://www.synapsed irect.com > Synapse - the use from anywhere EMR. > > -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
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