Difficult situation on refusing home health orders

[Socrates25]

I've got a situation where I have a pt who has a h/o chronic lung disease and has been O2 dependent up until the last 2-3 weeks. He has a home pulse ox. My plan (in agreement with the pulmonologist) was to continue home pulse ox for few weeks and then discontinue.

The home health company and insurance wont cover the cost since it doesnt "meet medical necessity" while I and the pulmonologist obviously disagree.

Now the insurance/home health people are calling me every day trying to force me to sign an order to d/c the home pulse ox, and I am refusing because I disagree with their "medical assessment" on this patient.

Here's the part that really pisses me off -- the insurance/home health are threatening to report me to the medical board for "fraud." Their argument is that the pulse ox is unnecessary and that I am committing fraud by forcing them to eat the cost of the pulse ox. I am not billing anything to the insurance for this.

Regardless of whether you think my decision to continue home pulse ox is correct or not, what are the ramifications of refusing to sign a d/c order? I call BS on them reporting me for "fraud." If they want to go pick up the pulse ox themselves, they are welcome to it but I am NOT signing an order indicating that it is medically appropriate to stop the pulse ox.

If the home health people want to make their own medical decision and get rid of the pulse ox, then they can have at it. But I refuse to provide medico-legal cover for them by signing an order when it is NOT my decision or in my best medical judgment to do so.

Thoughts?

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[michaelrack]

xxx

 

[Stitch]

I'd get the hospital legal team involved ASAP. The implications for liability either way are concerning, and they can at least help devise a plan that will cover you. The more people involved the safer you are, so bump it up the food chain. This really sucks. I've never had home health and insurance companies escalate to such a treat before. Good luck. I'd really like to know how this turns out.