Fraud

[buddababa]

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12 physicians sentenced to prison for $250M billing fraud - Becker’s ASC

Twelve Michigan- and Ohio-based physicians were sentenced March 9 to prison for their roles in a scheme to perform and bill for unnecessary procedures in exchange for opioid prescriptions.

www.beckersasc.com

 

[mid|ine]

Wow, those numbers and sentences are staggering

 

[Agast]

“12. David Yangouyian, MD, was sentenced to six months in prison and ordered to pay $35,480”

I’m most curious about what he did because that’s not a lot of money to owe compared to the $2 million guy…

 

[oneforfighting]

I feel like I see one of these stories every other month

 

[kstarm]

Maybe it is just because I am on the pain forum here but it always seems like it is pain management related practices that have fraud cases. I assume other specialties have similar bad apples and I just don't go looking for it...like fraud cases for Ob or peds, I just don't hear about those. What percentage of fraud cases against docs are pain management related vs other?


EDIT: Apparently Number 1 on the list has a Fundrazer page he created back in 2017 to help with lack of income while being investigated.

 

[BoardingDoc]

Maybe it is just because I am on the pain forum here but it always seems like it is pain management related practices that have fraud cases. I assume other specialties have similar bad apples and I just don't go looking for it...like fraud cases for Ob or peds, I just don't hear about those. What percentage of fraud cases against docs are pain management related vs other?


EDIT: Apparently Number 1 on the list has a Fundrazer page he created back in 2017 to help with lack of income while being investigated.

I'm generally just a lurker here as someone who briefly considered going into pain and still reads the forums, but this might help answer your question.

Reasonable study: Characteristics of Physicians Excluded From US Public Insurance Programs

Study that just looks at news reports about docs being arrested, but more directly answers your question: Characteristics of criminal cases against physicians charged with opioid-related offenses reported in the US news media, 1995–2019 - Injury Epidemiology

The TL;DR from 1 is: FM and psych are most likely to be banned from medicare 2/2 abuse of the system. As are people who are: older, male, DOs, IMGs, and who don't have a faculty appointment. Paper 1 does not parse out pain docs as a field.

TL;DR from 2 is: most news articles about arrested docs for opioid related offenses by specialty is: FM > IM > Pain >>> everything else

 

[kstarm]

I'm generally just a lurker here as someone who briefly considered going into pain and still reads the forums, but this might help answer your question.

Reasonable study: Characteristics of Physicians Excluded From US Public Insurance Programs

Study that just looks at news reports about docs being arrested, but more directly answers your question: Characteristics of criminal cases against physicians charged with opioid-related offenses reported in the US news media, 1995–2019 - Injury Epidemiology

The TL;DR from 1 is: FM and psych are most likely to be banned from medicare 2/2 abuse of the system. As are people who are: older, male, DOs, IMGs, and who don't have a faculty appointment. Paper 1 does not parse out pain docs as a field.

TL;DR from 2 is: most news articles about arrested docs for opioid related offenses by specialty is: FM > IM > Pain >>> everything else

Thanks, that's interesting about psych.

Overall is it opioid related cases >>>>>> non-opioid/pain fraud or vice versa?

 

[cowboydoc]

I'm generally just a lurker here as someone who briefly considered going into pain and still reads the forums, but this might help answer your question.

Reasonable study: Characteristics of Physicians Excluded From US Public Insurance Programs

Study that just looks at news reports about docs being arrested, but more directly answers your question: Characteristics of criminal cases against physicians charged with opioid-related offenses reported in the US news media, 1995–2019 - Injury Epidemiology

The TL;DR from 1 is: FM and psych are most likely to be banned from medicare 2/2 abuse of the system. As are people who are: older, male, DOs, IMGs, and who don't have a faculty appointment. Paper 1 does not parse out pain docs as a field.

TL;DR from 2 is: most news articles about arrested docs for opioid related offenses by specialty is: FM > IM > Pain >>> everything else

Thanks for this.

I’m sure resources are limited, but it seems there are a few bad actors that are so far out of the norm that it would be easy to do a cursory review of the top 1% of billing. These numbers are outrageous.

This wouldn’t eliminate fraud, as the “smart” ones know “pigs get fat, but hogs get slaughtered.” That said, most willing to commit Medicare fraud wouldn’t stick to a plan that boosted their profit by 25%.

 

[Agast]

Pain is rife with fraud because you have the most motivated patient participation. And it’s not all secondary gain. All those fraudulent back braces were for people desperate for relief.

 

[10KHertz]

If they didn’t pay us like sh.t, maybe there would be less fraud . Just a thought , not proven in science…

 

[Dr. Ice]

I don’t think pointed shoes and linked in rangers helps people who aren’t “them” feel warm and fuzzy about themselves. Pain docs are sensi, highly influenced and seem to want some moment of glory because they chose to listen to people complain about pain all day long.

All and all, it can be the perfect recipe for fraud if there is a slither of an avenue to get away with it

 

[Ducttape]

If they didn’t pay us like sh.t, maybe there would be less fraud . Just a thought , not proven in science…

we get paid pretty well for what we do.

i can talk for hours about my experience in 2 specialties where you work a lot harder with a lot more stress and a lot less pay than pain medicine. this is sweet gig.

 

[powermd]

This was not remotely the practice of medicine. It never ceases to amaze me how people think they can get away with fraud at a scale like this.

CEO Sentenced to Prison in $150 Million Health Care Fraud, Opioid Distribution, and Money Laundering Scheme

The chief executive officer of a Michigan and Ohio-based group of pain clinics and other medical providers was sentenced today to 15 years in prison for developing and approving a corporate policy to administer unnecessary back injections to patients in exchange for prescriptions of over 6.6...

www.justice.gov

"The evidence at trial showed that the Tri-County clinics valued making money over patient care. The Tri-County clinics intentionally targeted the Medicare program and recruited patients from homeless shelters and soup kitchens. Evidence at trial indicated that Rashid only hired physicians who were willing to disregard patient care in the pursuit of money. Rashid incentivized the physicians to follow the Tri-County protocol of offering opioid prescriptions and administering unnecessary injections by offering to split the Medicare reimbursements for these lucrative procedures. The specific injections used had nothing to do with the medical needs of the patients but were instead selected to be administered because they were the highest-paying injection procedures. A former Tri-County employee testified at the trial of Rashid’s co-defendants that the practices at the clinic were “barbaric.” "

 

[Agast]

. Rashid incentivized the physicians to follow the Tri-County protocol of offering opioid prescriptions and administering unnecessary injections by offering to split the Medicare reimbursements for these lucrative procedures.

Most employed docs are paid based on a percentage of collections. What a seedy to way to describe that…

 

[powermd]

Most employed docs are paid based on a percentage of collections. What a seedy to way to describe that…

There's obviously spin and slant on the part the the justice department, but the scale of the fraud speaks volumes about what was really going on.

 

[thecentral09]

This is literally unbelievable. Homeless shelters? Broooo

 

[Agast]

This is literally unbelievable. Homeless shelters? Broooo

Functional assessment post MBB:

Patient states he reached 80% improvement for the next four hours. He was able to significantly increase his activity level, including winning his bum fight (also hosted by the pain clinic).

 

[geauxg8rs]

Functional assessment post MBB:

Patient states he reached 80% improvement for the next four hours. He was able to significantly increase his activity level, including winning his bum fight (also hosted by the pain clinic).

First rule of bum fight club
-don’t tell the OIG

 

[Analgesia108]

Functional assessment post MBB:

Patient states he reached 80% improvement for the next four hours. He was able to significantly increase his activity level, including winning his bum fight (also hosted by the pain clinic).

😆

 

[Analgesia108]

Testimony at the trial established that in some instances the patients experienced more pain from the shots than from the pain they had purportedly come to have treated; that audible screams from patients were observed throughout the clinics; and that some patients developed adverse conditions, including open holes in their back.

The doc paying the most restitution is 64 yr old ER doc ....

 

[10KHertz]

we get paid pretty well for what we do.

i can talk for hours about my experience in 2 specialties where you work a lot harder with a lot more stress and a lot less pay than pain medicine. this is sweet gig.

Clearly you don’t own or run your own practice. it’s a sh.t load of work and stress… clocking in and out with your RVUs must be nice 😊

 

[lobelsteve]

Clearly you don’t own or run your own practice. it’s a sh.t load of work and stress… clocking in and out with your RVUs must be nice 😊

Yes. Yes it is.

 

[Ducttape]

Clearly you don’t own or run your own practice. it’s a sh.t load of work and stress… clocking in and out with your RVUs must be nice 😊

thats the business side that you voluntarily chose to do.

tell me... did you spend all those years of training in medical school and residency to learn how to do payroll?

 

[Agast]

thats the business side that you voluntarily chose to do.

tell me... did you spend all those years of training in medical school and residency to learn how to do payroll?

Outpatient medicine used to be 100% private practice. It’s kind of sad to view it as an outlier now…certainly not something to be snarky about. Business guys want medicine guys to think that business is too hard and complicated and we need to hand over the reins and clock in-clock out.

 

[Ducttape]

please be mindful that i was replying to 10Hertz, who was "being snarky" about how hard pain medicine is because of the business aspect.


ive had a few moments here or there if shear panic, and some episodes of utter befuddlement, while doing pain medicine over the past 10 years.

that was pretty much daily occurrence in the Acute side ER.

 

[Pain Applicant1]

thats the business side that you voluntarily chose to do.

tell me... did you spend all those years of training in medical school and residency to learn how to do payroll?

I don't think s/he did but it probably wouldn't be a bad idea to incorporate business training into residency.

 

[jsaul]

thats the business side that you voluntarily chose to do.

tell me... did you spend all those years of training in medical school and residency to learn how to do payroll?

This is what is crazy about it . A long time ago most docs who graduated went straight to opening up their own practice or joining another private doc after graduation. They had to learn about running a business on their own. Their was no formal education about this. But also many small businesses are the same. The cosmetician, flower shop, cookie store owner, all had to learn how to run a business on their own.

It can be done. I did it and so many other non doctor businesses do it. If these other small business owners can do it why can't a med school graduate learn it as well on their own.

Sometimes the hospital administration and the MBAs make it seem harder than it is in order to scare you not to open up your own shop.

 

[nvrsumr]

If I got paid same as a hospital doc it would be a cake walk to run my practice... from the beach

 

[Ferrismonk]

This is what is crazy about it . A long time ago most docs who graduated went straight to opening up their own practice or joining another private doc after graduation. They had to learn about running a business on their own. Their was no formal education about this. But also many small businesses are the same. The cosmetician, flower shop, cookie store owner, all had to learn how to run a business on their own.

It can be done. I did it and so many other non doctor businesses do it. If these other small business owners can do it why can't a med school graduate learn it as well on their own.

Sometimes the hospital administration and the MBAs make it seem harder than it is in order to scare you not to open up your own shop.

Four words: Student loans, insurance rules

I have no problem running a business, have done so successfully before. The thought that anyone can graduate residency with $300K+ in student debt and meet all the asinine insurance rules to get paid right out of the gate is crazy.

The only viable way for a new MD to hang out their own shingle immediately after training is if their schooling was paid for, they have a spouse who can pay the bills for a while, or they are single with no kids and moonlight for a while to supplement the practice.

It's not right, but that's the truth.

 

[MitchLevi]

Four words: Student loans, insurance rules

I have no problem running a business, have done so successfully before. The thought that anyone can graduate residency with $300K+ in student debt and meet all the asinine insurance rules to get paid right out of the gate is crazy.

The only viable way for a new MD to hang out their own shingle immediately after training is if their schooling was paid for, they have a spouse who can pay the bills for a while, or they are single with no kids and moonlight for a while to supplement the practice.

It's not right, but that's the truth.

Like so many things in modern times, "it's different these days."

 

[Pain Applicant1]

Four words: Student loans, insurance rules

I have no problem running a business, have done so successfully before. The thought that anyone can graduate residency with $300K+ in student debt and meet all the asinine insurance rules to get paid right out of the gate is crazy.

The only viable way for a new MD to hang out their own shingle immediately after training is if their schooling was paid for, they have a spouse who can pay the bills for a while, or they are single with no kids and moonlight for a while to supplement the practice.

It's not right, but that's the truth.

There are other ways. You just have to be creative. For example, I negotiated an income guarantee and loan forgiveness with the local hospital.

Also, if you get set up with payers and work on your referring docs prior to opening up it makes reaching profitability a lot easier.

 

[10KHertz]

If site for service payments are reversed , we will see a renaissance once again.

Many of you are happy living in the caves watching the shadows above … you have no clue what you gave up working for some indifferent medical system.

I am lucky to have a patient population that values elite service .

My advice is that if you are a new grad and have amazing skills (be honest with yourself), take the calculated risk and there is tremendous reward…

 

[Ferrismonk]

There are other ways. You just have to be creative. For example, I negotiated an income guarantee and loan forgiveness with the local hospital.

Also, if you get set up with payers and work on your referring docs prior to opening up it makes reaching profitability a lot easier.

The hospital gave you an income guarantee and loan forgiveness even though you didn't work for them?

 

[Pain Applicant1]

If site for service payments are reversed , we will see a renaissance once again.

Many of you are happy living in the caves watching the shadows above … you have no clue what you gave up working for some indifferent medical system.

I am lucky to have a patient population that values elite service .

My advice is that if you are a new grad and have amazing skills (be honest with yourself), take the calculated risk and there is tremendous reward…

I'll take it a step further. I don't even think elite skills are that important. As naive and unbelievable as it may sound, just be kind and caring to the pts and you'll have more pts than you'll know what to do with.

 

[runfastnow]

As a physician with MBA and MS Finance degrees you do not need either of these to own/run a private practice (although they do help you call bull$hit on all the banking/finance scams out there) ... just the guts and up front capital to remain solvent for 3-5 years until the machine is running on all cylinders. There is good value in bringing in a business minded (or trained) individual at some point once your practice is large enough, but if you can master 100 and 200 level finance/accounting you can run a successful practice and will pick up the rest of the knowledge as you make mistakes and learn from them.

The sad thing is that academics is rife with attendings who treat private practice or community physicians as physicians who are not "smart enough" to make it in academics and that mindset impacts trainees to become hospital/academic employees and join the academic pyramid scheme.

Not all MBAs are bad - in large hospital systems good people with M&A, corporate debt management, and marketing are worth their weight in gold, but MBAs do not need to be making admin or HR decisions on the patient facing/clinical level without physician input/oversight.

 

[Pain Applicant1]

The hospital gave you an income guarantee and loan forgiveness even though you didn't work for them?

Definitely did NOT work for them. I cold-called them once I targeted the area I wanted to be in. I met with the CEO, CFO, etc and gave them my presentation on how I would benefit them, the community, etc. They liked what i had to say but decided to take my idea and present it to the nearest university so they could hire someone themselves. Didn't work out for them and they called me and we worked out a deal. Once I made more than the income guarantee, which took I think about 10 months, I terminated the contract. It was forgiven if I stayed in the area for double the time of the contract. I also agreed to not build out an ASC so I couldn't compete with theirs.

Little did they know, had they not agreed to this, I still would have come into the area to open my practice. Lucky I pulled that one off.

 

[10KHertz]

I'll take it a step further. I don't even think elite skills are that important. As naive and unbelievable as it may sound, just be kind and caring to the pts and you'll have more pts than you'll know what to do with.

Yes agreed , empathy with nasty skills is a killer combo…

 

[ateria radicularis magna]

If site for service payments are reversed , we will see a renaissance once again.

Many of you are happy living in the caves watching the shadows above … you have no clue what you gave up working for some indifferent medical system.

I am lucky to have a patient population that values elite service .

My advice is that if you are a new grad and have amazing skills (be honest with yourself), take the calculated risk and there is tremendous reward…

What are amazing skills specifically ?

 

[BobBarker]

What are amazing skills specifically ?

I did 9 kyphos, two SI joint fusions, 3 implants, and a Minuteman yesterday. One CRNA. 7:30AM to 4:30PM.

 

[Dr. Ice]

Sij fusions..

 

[callmeanesthesia]

I did 9 kyphos, two SI joint fusions, 3 implants, and a Minuteman yesterday. One CRNA. 7:30AM to 4:30PM.

Sounds like they should start fortifying the water supply with calcium, vitamin d, and prolia near you…

 

[BobBarker]

Oklahoma had a terrible sleet event. Two to three inches of sleet accumulated. There are others that I haven’t fixed yet from the same event. We have at least two major snow or ice events per year and we don’t treat our sidewalks or streets.

 

[Darkside_]

I'm generally just a lurker here as someone who briefly considered going into pain and still reads the forums, but this might help answer your question.

Reasonable study: Characteristics of Physicians Excluded From US Public Insurance Programs

Study that just looks at news reports about docs being arrested, but more directly answers your question: Characteristics of criminal cases against physicians charged with opioid-related offenses reported in the US news media, 1995–2019 - Injury Epidemiology

The TL;DR from 1 is: FM and psych are most likely to be banned from medicare 2/2 abuse of the system. As are people who are: older, male, DOs, IMGs, and who don't have a faculty appointment. Paper 1 does not parse out pain docs as a field.

TL;DR from 2 is: most news articles about arrested docs for opioid related offenses by specialty is: FM > IM > Pain >>> everything else

Are they including mid-levels into these demographics? I see many patients being prescribed high doses of opioids from NPs and PAs who run their own primary care shops. The other day I had one that was being prescribed intranasal ketamine by an NP in NYC.

 

[BoardingDoc]

Are they including mid-levels into these demographics? I see many patients being prescribed high doses of opioids from NPs and PAs who run their own primary care shops. The other day I had one that was being prescribed intranasal ketamine by an NP in NYC.

No. This is docs only per both articles.

 

[avalon10]

"The physicians allegedly refused to prescribe opioids to patients with back pain unless they underwent facet joint injections, according to court documents"

Makes it sound like that's a bad thing.
"Refused to prescribe opioids" lol

 

[mid|ine]

"The physicians allegedly refused to prescribe opioids to patients with back pain unless they underwent facet joint injections, according to court documents"

Makes it sound like that's a bad thing.
"Refused to prescribe opioids" lol

I know, this is a fine line to walk. Damned if you do, damned if you don't. Opioid guidelines say patient should be participating in non-opioid options. I always offer and discuss non-opioid treatments, but don't force people to treatments they don't want, but I also only rx very low doses. My averaged daily morphine equivalent is <15.

 

[Ducttape]

the operative word is "unless".

 

[Ferrismonk]

It's all in the way you word things. I agree it's a fine line.

I have no problem weaning opioids on patients who don't engage in recommended non-opiate therapy. The conversation is never "get this shot or I'm taking away your opioids", but rather "Opioids are the most dangerous and least effective option I have for treating pain. Opioids are only indicated if all other indicated options, including physical therapy, pain psychology, lifestyle modification, interventional procedures, etc are being tried and continue to fail."

If they still decline, which is perfectly fine, I'll mention that the patient is not willing to engage in non-opioid treatments for their pain, which was agreed to in their opioid contract, and therefore I do not think that opioid treatment is warranted.

 

[clubdeac]

If site for service payments are reversed , we will see a renaissance once again.

Many of you are happy living in the caves watching the shadows above … you have no clue what you gave up working for some indifferent medical system.

I am lucky to have a patient population that values elite service .

My advice is that if you are a new grad and have amazing skills (be honest with yourself), take the calculated risk and there is tremendous reward…

What is this "tremendous reward" specifically. Was at a conference last week and another doc in private practice said the same thing to me

So I'm curious, how much better we talking? I understand the independence, autonomy and ability to call your own shots would be unbeatable however as a hospital employee my benefits are pretty stellar and my income seems quite reasonable for the amount of work I do. I see about 100 total patients per week after all the no shows fall off. Does tremendous reward mean $600k, 750k, 1 million annual income?

 

[Dr. Ice]

I can tell you as a private practice doc.. if I had to do it again, I would def go hopd employment. Honestly might even be considering making a move at some point soon. I’ve seen pp docs kill it..right place, right time, right decisions. I never had such luck and even things that looked stellar at the onset got destroyed by unpredictable situations. Knowing what I know now, If all I had to do was show up to work and get a piece of rvus, I would totally take it. Not all of us can churn and burn like drusso and I’ve definitely learned that about myself.