Anyone have experience using EBM Medical for compound pharmacy products? If so, what are your ethical concerns? Do you disclose the financial relationship to your patients? Seems like a potential kickback liability....
EBM Medical
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Many have gotten in trouble due to kickback situations with compounding medications.
The answer you will get is to contact a healthcare attorney and it is probably the right answer.
Some doctors have gotten together and formed a company and the money goes to the company and is then later dispersed to the owners to try a circumvent the kickback situation....wether this is a legit work around I have no idea. It sounds like things politicians do.
Even if you can avoid kickbacks charges, if you over prescribe expensive treatments you get paid for, you can still get in trouble with state boards.
The answer you will get is to contact a healthcare attorney and it is probably the right answer.
Some doctors have gotten together and formed a company and the money goes to the company and is then later dispersed to the owners to try a circumvent the kickback situation....wether this is a legit work around I have no idea. It sounds like things politicians do.
Even if you can avoid kickbacks charges, if you over prescribe expensive treatments you get paid for, you can still get in trouble with state boards.
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deleted1149159
As long as they aren't self referring, it CAN be legal. That being said, the really smarty pants doctors have a family member start the business, and work out how to be on the BoD of the company so their names aren't front and center. And THEN get dividends based on the profit of the company. All while referring patients to that company. People go through a lot of shenanigans to make money illegally.
@ExperiencedDPM any insight on this?
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State health departments and the Feds are actively looking for compounding pharmacy abuse. I’d be careful
Seattle-area foot clinics under state investigation for alleged 'kickback' scheme
Some excerpts…
“Those records say at least two podiatrists – Drs. Charles Chu and Ryan Bierman – conspired with a medical supply company to prescribe large amounts of medications to patients and share the profits from excessive billing to insurance companies.”
…
“David Boyovich, of Covington, was interviewed as part of the Department of Health’s (DOH) two-year investigation. He was contacted by DOH investigator Todd Terhaar with questions about the boxes of medications that arrived at his home after Boyovich’s wife broke her foot in 2017.
“I used a little bit (of the medication),” Boyovich told the investigator.
He said both he and his wife were confused by the tubes and bottle full of foot creams that arrived in the mail with names like Synerderm and Doxepin Hydrochloride Cream.
“I had no idea which ones to use. I got no instruction with it,” said Boyovich, who expected to receive only one tube of prescription cream from the doctor.
Then the following month, another box full of medicine arrived. More came the third month, which he turned away.
It wasn’t until investigator Terhaar called him a year later that he learned his insurance company had been billed $38,371 for the meds”
Seattle-area foot clinics under state investigation for alleged 'kickback' scheme
Some excerpts…
“Those records say at least two podiatrists – Drs. Charles Chu and Ryan Bierman – conspired with a medical supply company to prescribe large amounts of medications to patients and share the profits from excessive billing to insurance companies.”
…
“David Boyovich, of Covington, was interviewed as part of the Department of Health’s (DOH) two-year investigation. He was contacted by DOH investigator Todd Terhaar with questions about the boxes of medications that arrived at his home after Boyovich’s wife broke her foot in 2017.
“I used a little bit (of the medication),” Boyovich told the investigator.
He said both he and his wife were confused by the tubes and bottle full of foot creams that arrived in the mail with names like Synerderm and Doxepin Hydrochloride Cream.
“I had no idea which ones to use. I got no instruction with it,” said Boyovich, who expected to receive only one tube of prescription cream from the doctor.
Then the following month, another box full of medicine arrived. More came the third month, which he turned away.
It wasn’t until investigator Terhaar called him a year later that he learned his insurance company had been billed $38,371 for the meds”
Thanks for the reply, EBM seems a little more of a gray area since it is all cash pay, no insurance billed. But I'm sure there's still some potential liability...
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deleted1149159
Stark Laws don't discriminate between insurance payments and cash payments.
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Just stay away. If podiatrists have to turn to these ridiculous practices just to make a buck do you really think this is a good profession?
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Concur... in addition to "potential kickback liability," there is also look-at-yourself-in-the-mirror liability.
That'll happen when you try to stick pts with something $100+ with auto-refills that they could have gotten for $5 or $10 OTC.
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deleted1149159
Yes, of course, because Podiatry is the only profession on Earth where there are shady people, doing shady things to make a buck, right? EVERY profession has shysters. Give me a break.
Honestly, what is wrong with some of you? If you're that unhappy about the profession you chose, get out of it. Jeez.
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Podiatry is a medical profession. There are bad characters in every medical profession. But based on the experiences of most posters on here I think we all know a ton of podiatrists who cut corners all the time to make an extra buck. It is more prevalent than what is typically seen in MD/DO world. My two cents. Agree to disagree.
I thought Stark Law is specifically in relation to billing Medicare/Medicaid?
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Ummm....please don't check out the memes of podiatry thread
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It is more common because there are more solo practitioners and a bad job market. It is not because MDs are morally superior. Less oversight and one person making the decisions that benefits them directly in podiatry. Job saturation and many opening their offices who can not find a good job who struggle in the early years or longer adds to the temptation. Once bad habits are formed they continue.
Anyone who knows anything about internal auditing knows many normally good people do bad things when they have access and motivation. Podiatry has lots of solo doctors and motivation.... a bad job market. Podiatry is a perfect storm for fraud and scammy things. In the real world it is poor credit, drugs and gambling that often lead to people doing shady things and stealing. People with bad credit (or felonies) can usually not work around money.
I know so many solo podiatrists doing scammy things. It is such a typical story. They start working a day in another podiatrists office or nursing home etc and eventually open their own office and work there a couple days a week. Over time they give up their side hustles and work at their one office. Then over time open another location or two. They are doing well enough to make at least the average podiatrist salary if not a good bit more. It sounds like a great story then…BAM….they do scammy things like compounding meds and weird lab tests, kickback on hardware and sublets etc not to mention scammy coding or grossly over utilizing legitimate services. A couple years later they have a million or two million dollar home, expensive vacations multiple times a year, all kids at the most expensive private school, new prestige brand SUVs, spouse not working etc. It is really that night and day the income one can make with scammy things. Most get a very close call if not multiple or some board action eventually. Some never get caught and some lose their license completely. The ones who were doing very well already with a good insurance mix, good volume and ASC ownership are the ones more likely to hire attorneys and shield themselves a bit more and pick and choose what they get involved with. The struggling or doing average solo podiatrist which is the more common story tends not to get legal counsel or be as picky with which scammy things they get into.
It takes a strong person in solo practice to say no to all the scammy things.
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Precisely.
Podiatry, on average, falls somewhere between MDs and chiro in terms of rates of fraud, "clever practice management," selling OTC stuffs, goofy marketing, public and general medical respect, etc. That is because the DPM job market and saturation are also between the two.
It all comes down to saturation and supply and demand. I doubt most chiro legitimately want to do a series of full xrays, 10+ total spine manipulations (or whatever insurance will pay for) with little EBM, mitochondrial urine testing as cash pay service in the office, elderberry extract OTC, foot leveler insoles, refer to neuro or PT who give them kickbacks or return refers, various other office-sold vitamins based on "testing" results, etc etc for every patient who comes on with a basic headache or minor MVA whiplash. But can you really blame them when they have 200k or more in loans and only 6 or 8 patients per day despite being cutthroat competitive, paying YT, FB, Google, and premium practice website and newspaper ads? This is all after they went out to a semi-rural location so that they wouldn't be a literal stone throw from other DC practitioners in metro.
The opening schools without first creating high quality residency spots and researching job demand is a slippery slope. It's better to not let that wedge in the door. Podiatry will now have gone from 7 to 11 schools in ~20 years. We are judged by our lowest common DPM denominator. No, we won't wake up with a 20550 paying $10 or no patients to see, but it sure wont be inconsequential either. Even the well compensated DPM gigs like hospitals and well run PP will see wages creep down or raises stagnant if supply keeps climbing. It's inevitable. Pharmacists used to get out with much less debt and more job options, and now all most do is complain how bad retail (their version of PP associate) is and how they can't budge their loan burden.
Their pharmacist residency push is akin to podiatry fellowship push... a weird attempt to get a better job out of training. But at least pharma residencies tend to qualify a PharmD for hospital jobs (like a dent residency creates further specialty), whereas a DPM fellowship changes nothing... only more of what the podiatrist [should have] got in residency.
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The schools just don't want to accept they have not only a moral responsibility to make sure there are enough residencies but also not to increase the number of schools/slots for students until there is a decent job market.
They don't want to own that they should accept at least some of the responsibility for the shady things that go on due to saturation......nope diabetes is increasing and people are aging so we are sticking to that as a reason we need even more podiatrists. We said it before and it was not true 20 years ago, but we are sticking to it.
It is so sad with 3 year residencies for all (currently) we are still so much like Chiro in PP
They don't want to own that they should accept at least some of the responsibility for the shady things that go on due to saturation......nope diabetes is increasing and people are aging so we are sticking to that as a reason we need even more podiatrists. We said it before and it was not true 20 years ago, but we are sticking to it.
It is so sad with 3 year residencies for all (currently) we are still so much like Chiro in PP
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deleted1149159
My understanding is that if you have the patient sign an ABN, and charge them cash because Medicare doesn't cover it, and self refer, you are still in violation.
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deleted1149159
Sorry, but I don't understand this ideology. Why don't you hold every college and university to this standard? It's not a school's job to educate their students about future potential for them is it? This is mostly shirking one's own responsibility and pointing the finger.
Why is it that people make a $300K investment but are clueless about the future potential of this investment? Many spend more time massaging their stock portfolio than they do thinking about investing in their lifelong career.
Schools are also not responsible for the "shady things that go on". It has nothing to do with saturation. It has everything to do with individual greed.
ABN still requires sending the claim to Medicare. This is all cash, no insurance involvement whatsoever
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deleted1149159
Anything you dispense to a patient that they will pay cash for not, covered by Medicare, requires an ABN. Otherwise, it can be considered fraud.
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Yes. My last job I was not considered a Medicaid provider. I was not allowed to charge patient cash.
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Certainly researching a career beyond just podiatry school and national organizations websites is the responsibility of the potential student.
Individual fraud is also not a school's legal liability.
I do think you are being naive if you do not think a bad job market and saturation does not lead to more going into solo practice and doing more scammy things. It does. More schools and more slots for students will make things even worse.....if enrollment increases again.
The schools and some national organizations make false claims for the need for even more podiatrists to justify the expansion when they know this is not true. I feel this is morally wrong. We can agree to disagree.
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Regarding EBM, some of my colleagues have started using it and I've heard the pitch numerous times. I have refrained because it seems to shady for my taste. The way it works is that a patient is "prescribed" a topical or supplement and then it is faxed to EBM. EBM then contacts the patient, receives payment and mails the product to the patient, and then the prescriber gets a portion of the money back. Nothing is dispensed in the clinic. No insurance is accepted, only cash. They have all sorts of potions and pills, if the patient happens to order something else from the company unrelated, say a supplement for hair growth, the doctor would get a portion of that money as well.
The kicker in my mind is the patient is never told about the doctor getting a kickback, or even that its a OTC product they could find elsewhere, instead they are just told, "I'm writing you a prescription for..."
For example, a topical compounded cream might cost a patient $70 and then the doctor receives a $20 kickback off this. For their supplements, the company makes the patient buy 3 month supply at about $50 per month. I don't recall the kickback on this.
Again not my cup of tea...
The kicker in my mind is the patient is never told about the doctor getting a kickback, or even that its a OTC product they could find elsewhere, instead they are just told, "I'm writing you a prescription for..."
For example, a topical compounded cream might cost a patient $70 and then the doctor receives a $20 kickback off this. For their supplements, the company makes the patient buy 3 month supply at about $50 per month. I don't recall the kickback on this.
Again not my cup of tea...
More schools/students is the LAST thing this profession needs. We should be LIMITING the supply of podiatrists not expanding it. That'll give us more leverage with hospitals/employers/insurance plans as the population ages. Once the vast majority of residency grads can get GOOD jobs paying above 150k at a minimum, then maybe we expand the enrollment pool
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Yup. When our job market looks like that of CRNAs, then add all the schools you want. Our CRNAs just signed new contracts, they are salaried, no production, they rotate call. $300k. They can all get jobs anywhere in the country for similar pay (probably a little less in many non-rural places). They can also all do travel work anywhere in the country for more money. If I got fired tomorrow I’m not getting a job anywhere near where I live without opening up my own practice. There are 0 openings for employed positions in my state or the 3 surrounding states.
I just threw up
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I think the horse on this has been beat to death here, but TL;DR the schools and national organizations tend to over-promise the future and current prospects of the profession. So yes, it's borderline predatory to keep recruiting new students and keep building new schools to put an even greater amount of students per year in $350k debt. Given the fact that even more students will equal even worse job prospects for the whole cohort when they graduate residency. It's kind of daft to say it's the students responsibility to know this before they enter school. As a student, you can only do so much research until you just trust schools and national organizations to sell you straight on what they're offering. Unfortunately, they mostly are not.
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This.
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deleted1149159
Sorry, but every school in every profession does this. They want students. Right now, Law and Engineering do exactly the same thing. You guys seriously live in a bubble and complain about "OMFG Podiatry!" This happens everywhere, all the time. Do we need all these Universities full of Liberal Arts students? "Don't worry, you'll get something..." Do any of you have college age kids right now?
You guys are the naive ones thinking our profession is the bad gorilla. It's not. It's the same everywhere, in every field. No greater example than General Contractors. They get millions of dollars into debt on projects, take HUGE amounts off the top, pay off politicians to look the other way for inspections, and then go bankrupt, after putting the money they skimmed somewhere where it's untouchable. They go to jail for 5 years, pay the fines, and are still multi millionaires. This isn't the movies. I know multiple examples like this all over the USA. FL, TX, VA, PA, NJ. Crooks are everywhere. In every field.
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Your point is well taken .....the buyer needs to do their due diligence.
No matter what your ideology is on the issue the expansion is ridiculous.
There is not a great job market and solo practice is not getting easier.....yet more schools.
Why?
For profit DO schools that want another program and Texas pride I suppose. Leaders that either don't care or can do nothing about it.
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deleted1149159
Absolutely agree. No argument from on me on that at all.