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[doctorette]

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[IMreshopeful]

You need to be more specific about what he does

 

[rokshana]

You need to be more specific about what he does

And have solid proof

 

[Raryn]

Unless you truly believe he's committing criminal negligence, either find a mechanism by which this can be reported anonymously (hospital ethics line, some state medical boards...) to be investigated by an appropriate party or stay out of it. It's not worth risking your career.

 

[gutonc]

If you have documented proof of Medicare fraud, you can report him to CMS. Be sure that it's well documented, and truly fraud though.

If he's investigated and convicted, you stand to make a killing as a whistleblower and won't have to work again. If he's not convicted, you've ruined your career.

Actually, either way you've ruined your career. But at least in the first case, you'll make bank on it.

 

[Piebaldi]

If you have documented proof of Medicare fraud, you can report him to CMS. Be sure that it's well documented, and truly fraud though.

If he's investigated and convicted, you stand to make a killing as a whistleblower and won't have to work again. If he's not convicted, you've ruined your career.

Actually, either way you've ruined your career. But at least in the first case, you'll make bank on it.

How would OP ruin his/her career if attending was not convicted?

 

[Celexa]

How would OP ruin his/her career if attending was not convicted?

They are assuming word gets out and the OP is blacklisted by their medical community. One would hope that wouldn't happen but it's certainly not impossible.

However if the OP was able to stay anonymous presumably they would be fine professionally, albeit still with the distress of knowing the original problem still exists.

 

[gutonc]

How would OP ruin his/her career if attending was not convicted?

Word will get out. The OP will be blackballed.

 

[Crayola227]

Gotta love this profession sometimes.

 

[Arcan57]

Patient has a stroke, MI, trauma or something else that needs transfer to a tertiary facility that has stroke center, cath lab, trauma center. Attending doesn't want to give up the daily billing and refuses transfer.

For those of you who said to collect evidence or documented proof - how can I do this without violating HIPAA?

Do you have concrete proof they don’t want to give up the billing? If the population is as described, they may well be able to hide behind the opinion that such higher level of care was futile and unlikely to result in improved quality of life. There’s a very wide gulf (and a substantial burden of proof) between “bad care” and criminal fraud/abuse. What you’re describing doesn’t meet the CMS definition for fraud, and they’d likely be disinclined to go after someone who’s actually saving them money by avoiding costly and possibly futile care. You’d be significantly better off (if you are 100% certain of the motivation behind the behavior) making an anonymous complaint to your state’s medical board.

 

[rokshana]

Patient has a stroke, MI, trauma or something else that needs transfer to a tertiary facility that has stroke center, cath lab, trauma center. Attending doesn't want to give up the daily billing and refuses transfer.

Patient is not stable for discharge per some specialists, but patient's long term care facility is afraid of losing patient so attending discharges unstable patient anyway.

For those of you who said to collect evidence or documented proof - how can I do this without violating HIPAA?

if there is daily billing for those pmts, the decision was made by the ED that the pt didn't meet the time frame for emergent cath, tPa, level 1 trauma...unless they are decompensating on the floor...and even then, if they don't have the ability to get the pt to the tertiary center in time (what's the closest facility and how long does it take to get there?), medically it may not make sense.

 

[Apollyon]

If you're giving vague examples, it's not helping. If it's medical issues, it's a tough track. For example, when I was a med student, there was a married couple that were surgical residents. Every day (at least, when I was on service), 90 y/o women had serum HCGs drawn. All were negative, and no one questioned it. It was the wife in that couple, seeing if she was pregnant. Fun fact: that hospital is now out of business.

If it's surgical issues, doing unnecessary surgeries is easier to prove. As a corollary, procedure heavy IM subs (cardiology and GI) could be grouped in there. My co-resident, in his first job, was at a hospital where a cardiologist was doing excessive cardiac caths for the $$. He got caught, and, in the wake of the fallout from this, my past colleague got sued, and lost (pt he admitted for unexplained fever or something, but affirmatively did not have pneumonia on CXR, got broad spectrum Abx, which were decided to be not broad enough, and, in addition, pt got unneeded cardiac stents, and died; everyone sued, but all I know is that he lost).

 

[EyeGuy15]

Don't do anything now. If your attending is doing this stuff now, he won't stop (and will likely get worse) as times goes on. If you really want to do something, document as much as you can whenever you feel something is shady (patient info, details of the situation, dates of patient care etc). Make sure they are your patients as well, so you actually can access the medical records without it being a violation. Don't report anything until you have graduated. This is important for two reasons:

1. You want to be as far away from the situation as possible if you're going to report him, so no possible repercussions against you if he finds out it was you.
2. The more training/education you undergo throughout your residency, it is very possible that some/most/all of the "violations", weren't actually violations rooted in greed, and there was actually sound reasoning behind the decision making.

"Patient has a stroke, MI, trauma or something else that needs transfer to a tertiary facility that has stroke center, cath lab, trauma center. Attending doesn't want to give up the daily billing and refuses transfer." - Maybe the attending feels comfortable handling management of these patients and has a solid track record with these type of patients without transferring. Maybe he feels that transferring these patients 20-30 miles away isn't worth the inconvenience to the patient's family and friends who wouldn't otherwise visit the patient daily to offer support. Maybe he has dealt with issues with insurance companies that can be really difficult in these situations. Some insurance companies explicitly state that if you go to through the ED at one hospital, but care is transferred to another hospital, they may not feel the transfer was warranted and the patient can end up with some absurd bill from the second hospital. Maybe there is a push from administration to keep these patients (and care for them properly) so that your current hospital is recognized as a top-tier facility that has the resources/specialists to handle complex cases). Most of the billing for inpatient care goes to the hospital anyways. If patients are dying left and right because they are not being transferred that's a different story and more concrete, but that does not seem to be an issue.

"Patient is not stable for discharge per some specialists, but patient's long term care facility is afraid of losing patient so attending discharges unstable patient anyway." -Every hospital and insurance company pushes doctors to discharge patients as soon as possible. That's just the reality of medicine. Theoretically, most patient's aren't really 100% stable from every specialist's point of view who has seen them. Everyone can benefit from a day or two extra in the hospital to completely ensure every vital sign, lab, bodily function is completely normal, but thats not the reality of medicine. Insurance companies can be ruthless when it comes to not paying if they feel the patient did not need to still be there.

Wait until you have graduated and see how you feel about everything you witnessed and documented. If you still feel a type of way about the situations, turn over the info to the proper people (Insurance Panels, Medicare, State Licensing Board, Specialty Board), and move on. In the rare event, he knows/suspects it's you, you will be gone and he won't be able to touch you. In addition, so many residents will have rotated through his service, he won't have a clue who dimed him out. At the very least, if there are no concrete penalties against your attending when the investigations are complete, he will likely always be looking over his shoulder and go legit as possible.

 

[Crayola227]

Never make any move that might make waves before you've fully graduated residency, have passed your boards, and are fully licensed to practice. Period. Don't doubt for a minute that anything less can permanently end you.

 

[Merely]

I can't give away much information, but anyone who has suggestions, please PM me.

One of the attendings in my residency has a primary goal of maximizing his bottom line, regardless of patient care. I am pretty sure that if Insurance Panels, Medicare, State Licensing Board, and Specialty Board can obtain details of some of the things he has pulled off, they can hold him in violation or liable in multiple regards. The hospital turns a blind eye because he makes them money as well.

I've seen him do some pretty awful things to his patients, who are fittingly (for him) old, poor and demented without families.

How can a resident deal with this without jeopardizing our job?

What field is. This