accused of ins fraud!

[Doctor M]

Ok, i received a phone call today from a doctors office and spoke to the medical assistant or nurse or whomever calls in the docs rx's and she was concerned that we had dispensed a box of 5 rhogam syringes when the rx was only called in for 1 syringe. It seemed that it was an error on our part and I stated that I would rebill the ins for 1 syringe and have the pt return the 4 other syringes. Well this Docs representative accused me of over billing the ins company and she was going to report me to the ins company. She had my name so essentially she is going to call the ins company and report me personally for ins fraud. I find this to be a serious accusation from someone who has no idea what she talking about. I offered to rebill for the correct qty and she questioned as to why I couldn't only order 1 syringe. Well, from our supplier rhogam comes in 5,25 or 100 count boxes. When we filled it we ran it through for the whole box, not 1 syringe, a mistake that can be corrected. Instead, this lady accuses me of ins fraud which i find to be extremely serious and a bit slanderous if she proceeds to call the ins company and give my name as the responsible Rph. I work for a corporation in which overbilling would only hurt the comp, not my salary, so i have no reason to overbill from an ethical and monetary view. After all said and done she just hung up the phone, a very unprofessional move on her part. Any suggestions?

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[MountainPharmD]

I knew you were a bad seed. Insurance fraud, unbelieveable....Hey I think we need to black ball Doctor M!!!!

Just kiddding!!!! I wouldn't worry. After all we know what its like to call an insurance company and she doesn't. After she is placed on hold for an hour and transfered ten times and dsconnected twice she will give up.

 

[ZpackSux]

Ok, i received a phone call today from a doctors office and spoke to the medical assistant or nurse or whomever calls in the docs rx's and she was concerned that we had dispensed a box of 5 rhogam syringes when the rx was only called in for 1 syringe. It seemed that it was an error on our part and I stated that I would rebill the ins for 1 syringe and have the pt return the 4 other syringes. Well this Docs representative accused me of over billing the ins company and she was going to report me to the ins company. She had my name so essentially she is going to call the ins company and report me personally for ins fraud. I find this to be a serious accusation from someone who has no idea what she talking about. I offered to rebill for the correct qty and she questioned as to why I couldn't only order 1 syringe. Well, from our supplier rhogam comes in 5,25 or 100 count boxes. When we filled it we ran it through for the whole box, not 1 syringe, a mistake that can be corrected. Instead, this lady accuses me of ins fraud which i find to be extremely serious and a bit slanderous if she proceeds to call the ins company and give my name as the responsible Rph. I work for a corporation in which overbilling would only hurt the comp, not my salary, so i have no reason to overbill from an ethical and monetary view. After all said and done she just hung up the phone, a very unprofessional move on her part. Any suggestions?

M,

This is an unfortunate part of being in healtchare. The charges of fraudulant activities. At least she's not going to report you to CMS or Medicaid...and to be charged and convicted of medicaid or medicare fraud could mean some ugly situations leading to a criminal indictment..not civil penalties.

That being said, there must be a proof of intent to defraud. And no one will ever be able to prove that in your isolated incident. And in order for you to be charged criminally, you have to go to a jury trial. Of course most settle out of court.

In your situation, it will be a simple recoup and rebill. No fraud. Tell the nurse to go F**K off...or ask her when was the last time she got laid.

 

[Doctor M]

M,

This is an unfortunate part of being in healtchare. The charges of fraudulant activities. At least she's not going to report you to CMS or Medicaid...and to be charged and convicted of medicaid or medicare fraud could mean some ugly situations leading to a criminal indictment..not civil penalties.

That being said, there must be a proof of intent to defraud. And no one will ever be able to prove that in your isolated incident. And in order for you to be charged criminally, you have to go to a jury trial. Of course most settle out of court.

In your situation, it will be a simple recoup and rebill. No fraud. Tell the nurse to go F**K off...or ask her when was the last time she got laid.

Haha, I almost went to the office to tell her to F**k off. I was so pissed. Stupid a** Docs "represenative" being so unprofessional. I hope she calls one day to call in a rx, ill just put her to voicemail every time B**ch!! And it was an isolated incident; I've worked too hard to ever do anything to defraud the system, and for what? I guess I've just had it with the moaning and pissing about "my ins this, my ins that" or "I called this in last week and the pt says its not there..." BS. I wanna say, well you f**kin ******, did you leave all info needed to fill the rx, like the spelling of the name, DOB etc, you godforsaken piece of s**t or are u sure it was here and not the 200 other stores we have on every corner in this city?????... End of rant Anyway, Im over it and im gonna go play my XBOX soon

 

[Doctor M]

I knew you were a bad seed. Insurance fraud, unbelieveable....Hey I think we need to black ball Doctor M!!!!

Just kiddding!!!! I wouldn't worry. After all we know what its like to call an insurance company and she doesn't. After she is placed on hold for an hour and transfered ten times and dsconnected twice she will give up.

Agreed, but she was so unprofessional. I feel like going down there and asking her why she has to be do unprofessional and I want to see if she would be such a b--tch if she spoke to me in person. I mean come on, we are professionals, but sometimes these nurses or whomever calls in the rx's like to hide on the other end of the phone...b---ch. Yeah, talk to me like that in person...It would probably be a different stort then End of rant #2

 

[JerryPharmD]

I've worked with a moonlighting pharmacist that works in the fraud prevention department of a large PBM. It's possible that the person called you was pretending to be a doctor's rep. You did nothing wrong and the caller was very unprofessional. Keep your cool and you'll be fine.

 

[Doctor M]

I've worked with a moonlighting pharmacist that works in the fraud prevention department of a large PBM. It's possible that the person called you was pretending to be a doctor's rep. You did nothing wrong and the caller was very unprofessional. Keep your cool and you'll be fine.

Yeah... I always keep my cool. I never act out what Im thinking, otherwise Id be in jail

 

[pharmdch]

I'd write a letter to the physician condemning the unprofessional and discourteous manner of this individual. What can I say? I'm a hater, and this woman is clearly a human ashtray.

 

[Doctor M]

I'd write a letter to the physician condemning the unprofessional and discourteous manner of this individual. What can I say? I'm a hater, and this woman is clearly a human ashtray.

Yes, I think I will do this and hand deliver it to the doctor himself. I am really just sick and tired of being belittled by some office staff. I am a professional and will act like it... I cant let this go because it will just continue and continue and it doesn't have to.

 

[alwaystired]

Yes, I think I will do this and hand deliver it to the doctor himself. I am really just sick and tired of being belittled by some office staff. I am a professional and will act like it... I cant let this go because it will just continue and continue and it doesn't have to.

YAH. take a stand for us. show them that we are professionals too j/k but I do think this is a good idea. She has no right to be so rude and accuse you of fraudulent behavior.

 

[Doctor M]

YAH. take a stand for us. show them that we are professionals too j/k but I do think this is a good idea. She has no right to be so rude and accuse you of fraudulent behavior.

I mean think about it...Would any of us speak to a medical doctor or another pharmacist Like that? I wouldn't and never have...It's just about being a professional..

 

[WVUPharm2007]

We should make a push to force these people to be licensed to practice as "Medical Receptionist" or whatever. They have an important role....communicating with the dude handing out potentially dangerous **** to a patient. They need to be evaluated for competency and held accountable. I have wanted to strangle many of them in the past. Stupid ****heads.

 

[Doctor M]

We should make a push to force these people to be licensed to practice as "Medical Receptionist" or whatever. They have an important role....communicating with the dude handing out potentially dangerous **** to a patient. They need to be evaluated for competency and held accountable. I have wanted to strangle many of them in the past. Stupid ****heads.

You had me at hello...you had me at hello... Thats exactly what I was thinking...S**t, I might as well let my technician take the damn script over the phone. Some of the "little girls" have absolutely no business calling in "S-I-M-V-A-S-T-A-T-I-N, yeah, well, I think thats what the doctor wrote, umm, im not sure" BS. And most think they are extreme experts that they feel need to talk as fast as possible and mumble everything...stupid A$$es...end of rant #3

 

[twester]

Oh, such well-deserved venom. Part of the licensing process must include the ability to enunciate and speak at a reasonable velocity. If they can't pronounce the drug name, they have to be able to spell it.

Just today, I took a slurred and hurried dictation that I couldn't decipher (I listened to that damned message eight times). I called the doc's office back and made them speak veeerrrry sloooowly. They kept trying to speed it up, but I was determined to make it hurt. It turns out I was spot on with the script, but I can't guess with that sort of thing. I advised them of that and told them to take heed when they left their next voice message.

 

[pharmdch]

Doctor M,

Be sure to use a high quality 100% cotton bond, and pen the letter in your finest calligraphy; secure the envelope with a wax seal to convey a disquieting formality. The grievance, swathed in archaic splendor, will communicate the urgency and significance of the issue, while provoking a measured response to address the defamatory remarks and unsubstantiated claims directed at you. Subconsciously, the officious nature of the complaint will trigger anxiety, which the physician will alleviate by "correcting" the transgressor.


Gee. I almost want to write the letter myself. I'm stoked! H8R 4 Life

 

[Doctor M]

Doctor M,

Be sure to use a high quality 100% cotton bond, and pen the letter in your finest calligraphy; secure the envelope with a wax seal to convey a disquieting formality. The grievance, swathed in archaic splendor, will communicate the urgency and significance of the issue, while provoking a measured response to address the defamatory remarks and unsubstantiated claims directed at you. Subconsciously, the officious nature of the complaint will trigger anxiety, which the physician will alleviate by "correcting" the transgressor.


Gee. I almost want to write the letter myself. I'm stoked! H8R 4 Life

I like that approach, but it seems that would cost me some money to go buy the paper, envelopes... Really though, im keeping this to a high standard of professionalism.

 

[PharmDstudent]

Yeah... I always keep my cool. I never act out what Im thinking, otherwise Id be in jail

So scandalous, I don't even know what to say...

 

[StallionRx]

Dont sweat that *****, I doubt anything will come from it.

I really agree with the fact that those medical receptionists should be licensed and held to a level of competancy. Ive gotten calls where they dont even have their chart out to call things in. Yesterday I get a call from one calling in a Rx, I pick up the phone and they told me to hold on while they rummage through the chart. I wait a solid 2 minutes before I say, call me back when your ready. You call ME to put ME on hold? Are you crazy?

Some of them carry the biggest attitude. Another one calls in for 125 MG of Synthroid - I kindly said, I think you mean MCG. Her response- "WHATEVER" Followed by a sig delivered with marbles in her mouth to which I ask her to repeat. She says "I said QD, That means daily." THANKS FOR LETTING ME KNOW!, Ive been wondering what thats meant on the 270 other Rxs i filled today!

Its a shame that you remember the bad ones, cus 95% of my calls with docs office are you usually pretty well done.

 

[Doctor M]

Dont sweat that *****, I doubt anything will come from it.

I really agree with the fact that those medical receptionists should be licensed and held to a level of competancy. Ive gotten calls where they dont even have their chart out to call things in. Yesterday I get a call from one calling in a Rx, I pick up the phone and they told me to hold on while they rummage through the chart. I wait a solid 2 minutes before I say, call me back when your ready. You call ME to put ME on hold? Are you crazy?

Some of them carry the biggest attitude. Another one calls in for 125 MG of Synthroid - I kindly said, I think you mean MCG. Her response- "WHATEVER" Followed by a sig delivered with marbles in her mouth to which I ask her to repeat. She says "I said QD, That means daily." THANKS FOR LETTING ME KNOW!, Ive been wondering what thats meant on the 270 other Rxs i filled today!

Its a shame that you remember the bad ones, cus 95% of my calls with docs office are you usually pretty well done.

Like I said, why dont I just let my Certified tech take MD calls. I would never do that just b/c it is the law, but I still believe the "representative" from the doctors office need to be more courteous and professional when talking to other healthcare professionals. It just blows my mind sometimes...

 

[No1 Pusher]

Doctor M,

Are you going to let her do that to you?

I think you're scared.... (to confront them)

 

[no-see-um]

You had me at hello...you had me at hello... Thats exactly what I was thinking...S**t, I might as well let my technician take the damn script over the phone. Some of the "little girls" have absolutely no business calling in "S-I-M-V-A-S-T-A-T-I-N, yeah, well, I think thats what the doctor wrote, umm, im not sure" BS. And most think they are extreme experts that they feel need to talk as fast as possible and mumble everything...stupid A$$es...end of rant #3

Their whole job is to keep the doctor off the phone. It's sad that the medical profession has forfeited its important role in theraputic drug monitoring and prescription clarifications to unlicensed secretaries who don't know the slightest thing about medicine, and sometimes don't even want to pull files or read patient charts!

And voicemails perhaps the most terrible thing invented for calling in scripts. Rather than speaking to a person on the other line, it's invariably a secretary with a high pitched scratchy voice talking a mile a minute and spelling out the wrong things... They'd say, 'Hi I'm calling from Dr. Ramalamadingdong's office (Error #1- didn't identify herself, #2, WTF is the prescriber again?!)... calling in a prescription for M. Knight. Shyamalan (no spelling)... He needs Lisinopril 40mg, L-I-S-I-N-O-P-R-I-L (WHY THANK YOU, you just spelled a medication to a pharmacist!! Congratulations.)


And this one's my favorite ending: "If there are any problems please call us back at ###-####" (Thanks, now I have like 4 things I need to call you back on and try to reach some secretary/nurse who didn't even give her name).

Oh and the best are the controlled substance call-ins with no identification of WHO is calling it in, no DEA#, no license #, etc... And you call them back and they've left for the day. It does the worst disservice to the patient that uneducated secretaries are calling in these important medications. It, ultimately reflects poorly on practitoners. They should be educating their staff a little better.

I actually prefer the Texas laws with regards to medical office representatives- that doctors should have it documented who is allowed to call in prescriptions for them and it should be available upon request by the State, or Pharmacists, etc. Anyone could say she's a secretary (suppose we asked 'em to 'prove you're a secretary?' hillarious, eh?)- there are cases on the DEA website where this occurred! Having nameless secretaries calling in prescriptions just shirks responsibilities with regards to the treatment and makes them are no more than 'hench-men' and the 'goons' of the medical profession, doing the bidding that practitioners don't want to be responsible for.

That's my theory as to why handwriting on prescriptions is so terrible- that the whole persuit is in the diagnosis, but the pharmaceutical treatment's not as pressing for them. Scribble it off, send it to the pharmacy, and if it can't be interpreted, well all the more better! Berta the secretary will clarify.

 

[no-see-um]

Doctor M. I would have asked to speak to the practitioner if someone tried that with me. Secretaries are for the purpose of making health care more expedient, but as soon as they become a roadblock to health care and become accusatory, you speak with the practitioner, You don't have to take that crap, and they shouldn't be throwing around those kinds of words without cause or understanding of how pharmacies and health insurances operate.

At this point, I wouldn't make a big stink of it. It's beneath you to tangle with a ******* secretary, and it would look bad.

 

[no-see-um]

Some of them carry the biggest attitude. Another one calls in for 125 MG of Synthroid - I kindly said, I think you mean MCG. Her response- "WHATEVER" Followed by a sig delivered with marbles in her mouth

At that point, you have every right to ask her to fax the prescription written by the prescriber or put him or her on the line. My response to 'he's busy', is always, "That's okay, I'll wait". It's not 'whatever'. Partners in healthcare...

 

[Doctor M]

Doctor M,

Are you going to let her do that to you?

I think you're scared.... (to confront them)

Haha, I went to the ofice this morning and dropped off my complaint.
I exchanged no words, no nothings, just wrote a letter to the doctor in a most professional manner that stated perhaps this "represenatative" needs to be more careful in her language toward another perofessional I did praise his efforts in helping me resolve this issue...you know, the normal BS one would say to another professional...And no, I could not let this go because a lot of these "representatives" think they can treat us like crap "over the phone lines"...ok say it to my face... It had to be done...

 

[Doctor M]

Doctor M. I would have asked to speak to the practitioner if someone tried that with me. Secretaries are for the purpose of making health care more expedient, but as soon as they become a roadblock to health care and become accusatory, you speak with the practitioner, You don't have to take that crap, and they shouldn't be throwing around those kinds of words without cause or understanding of how pharmacies and health insurances operate.

At this point, I wouldn't make a big stink of it. It's beneath you to tangle with a ******* secretary, and it would look bad.

At this point it is over. I wanted my point to come across that i am there to service the patient, not to be humiliated or belittled by some over zealous "represenative" hiding on the other end of the phone line. It's up to the doctor to discipline her or not; and if he doesn't and she does it again, i just wont take her calls no more...fax me the rx instead. I dont take no more chit from anyone...even disgruntled patients are asked to calm down and to be civil...Yeah I know, its retail, but I will take some abuse from sick people, but from abusive Docs representatives...nope, sorry. Thats where I draw the line...

 

[no-see-um]

At this point it is over. I wanted my point to come across that i am there to service the patient, not to be humiliated or belittled by some over zealous "represenative" hiding on the other end of the phone line. ...

Yeah I know, its retail, but I will take some abuse from sick people, but from abusive Docs representatives...nope, sorry. Thats where I draw the line...

I agree with that. I probably wouldn't have written up a whole letter on the subject and just try to forget about it, but it's certainly within your right and I applaud you for going that extra mile to make pharmacy/provider's office contact a little more civil and professional.


Some secretaries think that calling up a pharmacy is the equivalent of calling up a pizza place. She could very easily have said, "you put sausage on my pizza, and you charged me for extra cheese!! That's fraud and a health hazard, and I'm reporting you to the Better Business Bureau!!"

Normal Response: "But mam, we can fix this and easily refund your money"
Secretary: "NO THIS IS JUST WRONG!!! I'M REPORTING YOU TO THE BBB, THE IRS, THE FDA, INS... -"

 

[Doctor M]

I agree with that. I probably wouldn't have written up a whole letter on the subject and just try to forget about it, but it's certainly within your right and I applaud you for going that extra mile to make pharmacy/provider's office contact a little more civil and professional.


Some secretaries think that calling up a pharmacy is the equivalent of calling up a pizza place. She could very easily have said, "you put sausage on my pizza, and you charged me for extra cheese!! That's fraud and a health hazard, and I'm reporting you to the Better Business Bureau!!"

Normal Response: "But mam, we can fix this and easily refund your money"
Secretary: "NO THIS IS JUST WRONG!!! I'M REPORTING YOU TO THE BBB, THE IRS, THE FDA, INS... -"

Thanks, I just do whats right. Believe me, I was in "angry mode" after she hung up the phone. Luckliy I didn't go down there right there and then b/c I wasn't in any mood to be civil. after sleeping it off and thinking about it last night, I decided that the correct course of action would be to be civil and just write a quick complaint. And if the Doc blows it off, then so be it. I know I was right and i was "wronged". Accusations of ins fraud to me are serious as there are serious consequences for commiting fraud. She had no right to say that. I dont go around accusing docs of malpractice just because a pt didn't get better after a round of antibiotics, I mean WTF????What a loser she is...

 

[Doctor M]

I agree with that. I probably wouldn't have written up a whole letter on the subject and just try to forget about it, but it's certainly within your right and I applaud you for going that extra mile to make pharmacy/provider's office contact a little more civil and professional.


Some secretaries think that calling up a pharmacy is the equivalent of calling up a pizza place. She could very easily have said, "you put sausage on my pizza, and you charged me for extra cheese!! That's fraud and a health hazard, and I'm reporting you to the Better Business Bureau!!"

Normal Response: "But mam, we can fix this and easily refund your money"
Secretary: "NO THIS IS JUST WRONG!!! I'M REPORTING YOU TO THE BBB, THE IRS, THE FDA, INS... -"

Haha, thats funny, i even said have the pt bring back the syringes and can I easily rebill the ins...but NO, she had to say that I was overbilling the ins company and that was ins fraud...I am going to report you yada yada yada...Please, get a life

 

[WVUPharm2007]

The one thing that REALLY kills me is when I call about some sort of therapeutic substitution...say I call to ask if I can substitute a non-AB rated generic for a brand medication. You ask the receptionist...and without asking the physician, she just goes, "I'm sure that fine."

Who the **** gave her prescriptive authority? Why is it that *I* - the purported pharmaco-****ing-therapy expert - isn't legally allowed to make that decision, yet some twit with a GED on the other end of a phone shopping on eBay between patients can?

 

[BMBiology]

Like I said, why dont I just let my Certified tech take MD calls. I would never do that just b/c it is the law, but I still believe the "representative" from the doctors office need to be more courteous and professional when talking to other healthcare professionals. It just blows my mind sometimes...

The AMA is much stronger than the APhA.

 

[Doctor M]

The AMA is much stronger than the APhA.

Yeah, I concur.

 

[no-see-um]

The one thing that REALLY kills me is when I call about some sort of therapeutic substitution...say I call to ask if I can substitute a non-AB rated generic for a brand medication. You ask the receptionist...and without asking the physician, she just goes, "I'm sure that fine."

Who the **** gave her prescriptive authority? Why is it that *I* - the purported pharmaco-****ing-therapy expert - isn't legally allowed to make that decision, yet some twit with a GED on the other end of a phone shopping on eBay between patients can?

HAHAH. Would you take that okay, though? It totally forfeits the prescriber's responsibility to care about drug therapy. They love not having that responsibility. Put Berta, G.E.D. (Good-enough-diploma) on the case, and then if it ever came back to the prescriber, he could always be like, "hey now, I never said to switch! And what prescriber would give his secretary that right to say that? Certainly not me!" It totally shirks responsibility...

I usually ask if they could 'pull the patient file for the doctor and I say to call us back' and they could leave a message for us on how to proceed.

 

[no-see-um]

Like I said, why dont I just let my Certified tech take MD calls. I would never do that just b/c it is the law, but I still believe the "representative" from the doctors office need to be more courteous and professional when talking to other healthcare professionals. It just blows my mind sometimes...

Yeah, there's something to be said about how presumptuous it is for a secretary to call the pharmacy and be like, 'pharmacist, please'- no hi, no nothing, and have a direct access to the pharmacist versus having a secretary talk to a secretary. Sometimes I'd be thinking, "Hell, I should have just gotten my GED back in High School and been a secretary! Then I'd have the power to do an AB substitution like that and demand to speak to a pharmacist rather than to a technician who's probably gone to school even longer!"

 

[no-see-um]

I love this thread... Gotta vent a little

 

[Doctor M]

I love this thread... Gotta vent a little

Im still ventng!

 

[StallionRx]

Oh yea, this is a great thread.

Their self appointed ability to sub meds is crazy and I know it happens all the time.

I thought they only pulled that near me.

 

[soyroger]

So did you get a response from the doctor about what he's going to do to prevent this lady from repeating her bad behavior? Sending the letter was a great way to handle it, but following that up with a "What are you going to do about this?" to the MD would be the icing on the cake. Actually, if this doctor's office is at a facility large enough to have an HR department then I'd forward the letter to them so that they can start a file on her. The medical center I worked at before allowed anyone to be a whistle blower whether you worked there or not. That's one way to stop her from bugging you in the future. Kudos for being the professional one and giving Pharmacists a good name.

 

[Doctor M]

So did you get a response from the doctor about what he's going to do to prevent this lady from repeating her bad behavior? Sending the letter was a great way to handle it, but following that up with a "What are you going to do about this?" to the MD would be the icing on the cake. Actually, if this doctor's office is at a facility large enough to have an HR department then I'd forward the letter to them so that they can start a file on her. The medical center I worked at before allowed anyone to be a whistle blower whether you worked there or not. That's one way to stop her from bugging you in the future. Kudos for being the professional one and giving Pharmacists a good name.

Thanks as far as following up, I a think I am done. I have made my point and will move on. Going to their HR...eehhhh...I dont want to open p a can of worms...Ill let the doc do that if he choses. Anyway, on my way to another day of "represenatives" giving order

M

 

[No1 Pusher]

Doctor M,

I think you're scared to do a follow up.

Maybe It was the Physician himself who ordered the secretary to deliver the accusation over the phone because He is 'too busy'. You have to find out the truth. lol

 

[Doctor M]

Doctor M,

I think you're scared to do a follow up.

Maybe It was the Physician himself who ordered the secretary to deliver the accusation over the phone because He is 'too busy'. You have to find out the truth. lol

Honestly, if I were scared, i wouldn't have gone down there. Actually, as soon as the incident occured I left the pharmacy (we had overlap and werent busy) and went to the office. Of course the office was closed. And if it was the physician (i highly doubt it) then he was the coward for not confronting me about it. I doubt it was the physician. The patient probably called, bitched at the front desk girl and then called me to bitch me out. Who knows...Im over it, wrote my letter and ill just wait for the next one to come around!!

 

[meister]

The funny part to me is that it really wasn't insurance fraud, because you dispensed five syringes and not one. What a *****.

 

[Doctor M]

The funny part to me is that it really wasn't insurance fraud, because you dispensed five syringes and not one. What a *****.

Haha, she was a tool!