“Can I have something for pain?”
“We need to find a non medication way to attempt to treat this. Let’s try an ESI first”
Is that viewed as a trade ?
I doubt it. But making everyone go through every intervention their insurance will pay for, when you know it's not indicated, in exchange for pills, is. For example, you tell them they can't have the opiates they want and instead they need interventions. Then they tell you they already had ESIs, mbb/rfa, SIJ, stim trial, trigger points already and they didn't help. You tell them, too bad, you can't have opiates unless you do these shots we both know are futile, but if you agree to the shots (that you know are futile) you'll give them whatever opiates they want. The right thing to do, would be to not do futile shots and either not give them opiates either (if you think that's also futile in their case) or give them the opiates if you think they are indicated without coercing a patient into futile care.
Here, think about this. You're the Feds. A whistleblower from docs office tells you the doc is essentially selling pills for procedures. You send in 5 undercover officers all with normal backs, no pain and normal MRIs. You give them a script to ask for opiates and tell the doc they've had every procedure known to man and they didn't help. If the doc says, "By the looks of it you don't need the injections, I agree. But your imaging is so normal I see no reason you need a lifetime of opiates, either," then you pass, they're not likely to get too excited about that. On the other hand, if you recommend some sort of treatment that is medically justified, you're probably okay. On the other hand, if you ignore that they just told you their back doesn't hurt right now and ignore their stone cold normal MRI and say, "You have to go through a round of injection if you want pills," then you fail. They know they're on to something and they're going to dig deeper.
Remember, the agent just told you the injections are futile, unnecessary and he's teeing it up for the doc to essentially confess to a fraudulent care for pills scheme. And he's got it all on tape. Then they send in 5 more agents demanding narcs, and again, the doc coerces all of them to do a bunch more treatments the agents can later prove were obviously futile (they told you their back didn't hurt today, stone cold normal imaging, records + verbal report that same treatments were tried multiple times and did nothing or made the pain worse) then you're screwed.
Just do the right thing for the patient in front of you and what seems reasonable and you shouldn't have to worry. If doing that somehow allows you to earn 10 times MGMA, they reconsider that what you think is the right thing, might not be, according to the feds and likely a jury of people making 1/10th of MGMA. Single events and borderline or questionable gray area stuff is not likely to get you into trouble. You have to be doing some really sleazy s**t on a major scale to get the Feds attention and justify them taking you up as a federal case, considering all the other high dollar scams out there, for them to go after. In the same way an IRS agent will get laughed out of his job for prosecuting someone for not reporting $50 of taxes on tip money, the DEA & US attorney's have to be able to justify spending years and hundreds of thousands of dollars in going after you. One disgruntled patient or one borderline ESI, isn't likely to do it.
Remember the old saying, "Pigs get fat, hogs get slaughtered." There's a lot of truth to it.
