Is reporting a doctor for fraud (upcoding/overdocumenting) likely to go anywhere?

[Trismegistus4]

Let's say you knew of a doctor who was routinely documenting things they didn't do (i.e., dropping time-based/psychotherapy statements into notes stating that they spent 30 minutes face-to-face with a patient when they spent nowhere near that long) and billing the highest level billing code on every encounter despite spending almost zero time with patients and putting no effort into anything.

Would reporting them to Medicare/the state/some other agency likely result in any action being taken?

Purely hypothetically speaking, of course.

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[splik]

If this involves medicare fraud, then may get some money for this, under the qui tam provision of the Federal False Claims Act. You get a lawyer, they obviously take a big cut but they will review the case. You can also make a complaint without a lawyer. But yes, this is a serious issue if it can be proven. For example, if the claims show they are seeing more patients than could have possibly been seen etc.

 

[calvnandhobbs68]

I think your main issue with this is...how are you gonna prove it? When there are things like very clearly provable fraud like patient encounters that never happened, medical equipment/devices that were never actually provided (a classic Medicare fraud), procedures that were never done it's a lot easier.

Upcoding? That's what insurance audits are there for and actual recoverable "fraud" from that is just the difference between what the codes should be and what they actually are. So like whatever the difference is between a 99214 vs 99215 or 99213 vs 99214. "Putting no effort into it" doesn't matter if you're billing by MDM anyway and if you're an huge outlier in terms of coding, you end up getting tagged by insurance at some point.

The time thing? If it was literally impossible for this person to spend that much time with every patient, possibly something there. If they're scheduling the patients for a certain time slot and not actually using that whole time slot, what are you doing, sitting in the room recording their start and stop times for every patient? Like, how do you even know this?

 

[Trismegistus4]

The time thing? If it was literally impossible for this person to spend that much time with every patient, possibly something there. If they're scheduling the patients for a certain time slot and not actually using that whole time slot, what are you doing, sitting in the room recording their start and stop times for every patient? Like, how do you even know this?

It's an inpatient gig. The person spends maybe 1 hours tops rounding on 12-14 patients (including new admissions,) copies forward yesterday's note, and leaves at noon.

 

[TexasPhysician]

It's an inpatient gig. The person spends maybe 1 hours tops rounding on 12-14 patients (including new admissions,) copies forward yesterday's note, and leaves at noon.

Let’s say hypothetically that you are correct. You will need proof that it is repetitive fraud related to government insurance plans. Physicians rarely make actionable reports. A report likely to result in action would be something like an audit report involving many government insurance patients in which 40 90836 visits were billed in 1 day.

The proof needs to be clear enough that someone relatively unfamiliar with medicine could see that this is clearly wrong.

Just reviewing what you have posted, how can you be sure that the psychiatrist isn’t doing more than you describe? I’ve met a psychiatrist that would show up and pre-round. He would arrive before anyone else and review charts and check to see if anyone is awake for round 1. Then he would go see ER consults. Then he would return to the unit and do round 2 of checking on everyone. He already reviewed nursing notes and counseling notes, so he already knew who was progressing from earlier. Rounding done in 1 hour this time. Then notes created and move on to consults or outpatient. Sometimes he would return after consults slowed to recheck round 3. Nothing in this example is fraud.

How are you sure this isn’t happening? I get that your psychiatrist is unlikely doing this, but you need hard proof.

 

[Merovinge]

I wish people weren't quite so quick to discourage fraud reporting, these docs hurt real people and other doctors. You do need to dot every i and cross every t 5 times over, but if someone is billing 30 patients for 30 min psychotherapy codes on an IP unit daily and spending only a few hours total in the hospital, that would certainly be something to look into.

I think almost every doctor in every specialty has run into someone who clearly is overbilling, the question is what is the egregious line in the sand that triggers someone to do this type of reporting. You would need to discuss the specifics more to really drill down if this is it, but it sounds like it could be.

 

[comp1]

Ugh, this kind of stuff is why I prefer salaried shift work.

 

[TexasPhysician]

I wish people weren't quite so quick to discourage fraud reporting, these docs hurt real people and other doctors. You do need to dot every i and cross every t 5 times over, but if someone is billing 30 patients for 30 min psychotherapy codes on an IP unit daily and spending only a few hours total in the hospital, that would certainly be something to look into.

I think almost every doctor in every specialty has run into someone who clearly is overbilling, the question is what is the egregious line in the sand that triggers someone to do this type of reporting. You would need to discuss the specifics more to really drill down if this is it, but it sounds like it could be.

I think one of the main reasons we discourage it is because it is usually based on limited data and subjectivity rather than facts.

I’ve been reported to various entities more than all other psychiatrists in my group combined. Every time it is related to something so ridiculous that the issue is dropped in the first round of review.

Additionally I’ve worked on the other side - where I review cases. There isn’t “investigators” in early stages. No one evaluates all reports by invading clinics left and right. Man power isn’t spent going down a rabbit hole because someone said someone isn’t being 100% truthful. There needs to be hard facts, proof.

 

[ObsequiousAplomb]

If it's inpatient, most of them really are high MDM. If they aren't, they should be being discharged. It's not hard at all to make the MDM max level on IP. If someone is putting time statements in their notes that are excessive, my guess is the hospital billers told them they had to.

In a 5-day psychosis admission, days 2-4 are really almost the same progress note. If you manage to put in variety, then good for you.

I'm more concerned that this person wants to report the psychiatrist instead of having a conversation with the psychiatrist. Maybe they'd learn something!

 

[calvnandhobbs68]

I mean yeah most of this falls into the realm of insurance auditing. If the insurance company has a problem with someone writing the same note over and over and still billing a level 5 every day, they can deal with it. If they want to try to cross check whether it was physically possible for someone to see 10 hours worth of billing every single day, fine.

Since it's inpatient, you could always approach this with the hospital billing department and mention something like "oh when I'm cross covering Dr. Xs patients, I noticed his billing and notes seem different than mine despite having similar patient loads, should I be billing higher level codes?". If they really feel his coding/billing is outside of the norm, they don't want money clawed back either. But maybe they tell you to start billing everyone level 5 too lol.

The other question that would come up with this is, how do you know he's doing this for all patients he's seeing and it's upcoding? What reason do you have to be looking at his patient notes every day and tracking the amount of time he spends on the unit? If this doesn't go your way, you just end up seeming like a creeper and possibly HIPAA violations for going into a bunch of patient charts you didn't need to be in unless you're literally cross covering all of his patients all the time.

 

[Candidate2017]

Let's say you knew of a doctor who was routinely documenting things they didn't do (i.e., dropping time-based/psychotherapy statements into notes stating that they spent 30 minutes face-to-face with a patient when they spent nowhere near that long) and billing the highest level billing code on every encounter despite spending almost zero time with patients and putting no effort into anything.

The real travesty is why isn't he billing on medical decision making complexity? Why would he routinely bill inpatient based on face to face time if he is in and out quickly?

And, time based billing is based on total time, which includes chart review. Everyone knows proper chart review makes for quick, efficient rounding that makes it appear... effortless. 1 minute spent chart reviewing or querying staff probably saves 5-10 minutes of face to face time. So how do you actually know he's "putting no effort into anything." And if he is listing 30 minutes for time based billing, he is actually billing at the lowest follow up level (99231).

So many strange inconsistencies in this hearsay story.

Since it's inpatient, you could always approach this with the hospital billing department and mention something like "oh when I'm cross covering Dr. Xs patients, I noticed his billing and notes seem different than mine despite having similar patient loads, should I be billing higher level codes?". If they really feel his coding/billing is outside of the norm, they don't want money clawed back either. But maybe they tell you to start billing everyone level 5 too lol.

The other question that would come up with this is, how do you know he's doing this for all patients he's seeing and it's upcoding? What reason do you have to be looking at his patient notes every day and tracking the amount of time he spends on the unit? If this doesn't go your way, you just end up seeming like a creeper and possibly HIPAA violations for going into a bunch of patient charts you didn't need to be in unless you're literally cross covering all of his patients all the time.

Lol the most likely outcome is admin rakes them both over the coals for underbilling. And yeah, don't creep on charts.

 

[docloufan]

Let's say you knew of a doctor who was routinely documenting things they didn't do (i.e., dropping time-based/psychotherapy statements into notes stating that they spent 30 minutes face-to-face with a patient when they spent nowhere near that long) and billing the highest level billing code on every encounter despite spending almost zero time with patients and putting no effort into anything.

Would reporting them to Medicare/the state/some other agency likely result in any action being taken?

Purely hypothetically speaking, of course.

If you KNOW they didn't do. Yes.

How do you know? Need alot of evidence.

 

[Trismegistus4]

Like, how do you even know this?

How are you sure this isn’t happening?

I understand the skepticism, but I'm right there. I see it with my own eyes every day.

I get what you guys mean about the proof issue, though. I can see how it would be very hard to prove this to the standard that I imagine the law/regluations require, without literally following someone around the entire time they're there with a stopwatch.

Ugh, this kind of stuff is why I prefer salaried shift work.

That's the thing. We are salaried, with no productivity bonus. This person doesn't even gain any advantage from doing this. Although the department does occasionally show us numbers, and this person's are routinely like 50% higher than everybody else's (not just mine,) so it's surprising this hasn't already raised a red flag.

What reason do you have to be looking at his patient notes every day and tracking the amount of time he spends on the unit?

And yeah, don't creep on charts.

It's not uncommon for me to take over care of a patient this person has previously seen.

The real travesty is why isn't he billing on medical decision making complexity? Why would he routinely bill inpatient based on face to face time if he is in and out quickly?

And, time based billing is based on total time, which includes chart review.

I'd have to check the general boilerplate time-based statement in our note template, but the psychotherapy statement (which this person sometimes uses) specifically says "I spent X minutes face-to-face with this patient" and my understanding is that to use the psychotherapy add-on code, you literally do have to spend at least that many minutes face-to-face with the patient.

As for why, I don't want to go into too much detail, but I don't really think there is much of a thought process behind this. There's no "there" there. This person really does not come across as intelligent enough to be a doctor (even a lowly psychiatrist like us.) I can't understand how they managed to pass the steps. I know it's hard to believe, but I'm confident that if any of you could be around this person for 5 seconds, you would see what I mean.

 

[calvnandhobbs68]

I understand the skepticism, but I'm right there. I see it with my own eyes every day.

I get what you guys mean about the proof issue, though. I can see how it would be very hard to prove this to the standard that I imagine the law/regluations require, without literally following someone around the entire time they're there with a stopwatch.


That's the thing. We are salaried, with no productivity bonus. This person doesn't even gain any advantage from doing this. Although the department does occasionally show us numbers, and this person's are routinely like 50% higher than everybody else's (not just mine,) so it's surprising this hasn't already raised a red flag.




It's not uncommon for me to take over care of a patient this person has previously seen.


I'd have to check the general boilerplate time-based statement in our note template, but the psychotherapy statement (which this person sometimes uses) specifically says "I spent X minutes face-to-face with this patient" and my understanding is that to use the psychotherapy add-on code, you literally do have to spend at least that many minutes face-to-face with the patient.

As for why, I don't want to go into too much detail, but I don't really think there is much of a thought process behind this. There's no "there" there. This person really does not come across as intelligent enough to be a doctor (even a lowly psychiatrist like us.) I can't understand how they managed to pass the steps. I know it's hard to believe, but I'm confident that if any of you could be around this person for 5 seconds, you would see what I mean.

You're thinking about this the wrong way man.
"This guy is dumb" doesn't equal fraud.
You seeing some notes this guy wrote that seem upcoded doesn't equal fraud.
If there's no financial incentive to do this that makes it even more UNLIKELY anyone would think this is fraud.

You need to have persistent hard large amounts of evidence that this person is intentionally billing for services he didn't provide. Even the upcoding thing can be explained away....you know how many psychiatrists I still see on facebook groups that can't figure out the difference between time based and complexity based billing? "Oops guess I misunderstood what the billing department told me sorry" is an extremely easy way to explain this away.

 

[Merovinge]

I understand the skepticism, but I'm right there. I see it with my own eyes every day.

I get what you guys mean about the proof issue, though. I can see how it would be very hard to prove this to the standard that I imagine the law/regluations require, without literally following someone around the entire time they're there with a stopwatch.


That's the thing. We are salaried, with no productivity bonus. This person doesn't even gain any advantage from doing this. Although the department does occasionally show us numbers, and this person's are routinely like 50% higher than everybody else's (not just mine,) so it's surprising this hasn't already raised a red flag.




It's not uncommon for me to take over care of a patient this person has previously seen.


I'd have to check the general boilerplate time-based statement in our note template, but the psychotherapy statement (which this person sometimes uses) specifically says "I spent X minutes face-to-face with this patient" and my understanding is that to use the psychotherapy add-on code, you literally do have to spend at least that many minutes face-to-face with the patient.

As for why, I don't want to go into too much detail, but I don't really think there is much of a thought process behind this. There's no "there" there. This person really does not come across as intelligent enough to be a doctor (even a lowly psychiatrist like us.) I can't understand how they managed to pass the steps. I know it's hard to believe, but I'm confident that if any of you could be around this person for 5 seconds, you would see what I mean.

This stuff happens fairly regularly actually. There is a local hospital chain where one of the psychiatrists was beating out all the neurosurgeons in RVUs the one year I saw the data, he was close to 13,000. Now I've cared for many of his patients and it's clear how he gets there, he has a real reputation for his practice style. I imagine he might be bending minutes a bit, but he does in fact see a metric ton of patients day-in and day-out and it's certainly not overt fraud.

 

[Candidate2017]

That's the thing. We are salaried, with no productivity bonus. This person doesn't even gain any advantage from doing this.

As for why, I don't want to go into too much detail, but I don't really think there is much of a thought process behind this. There's no "there" there. This person really does not come across as intelligent enough to be a doctor (even a lowly psychiatrist like us.) I can't understand how they managed to pass the steps. I know it's hard to believe, but I'm confident that if any of you could be around this person for 5 seconds, you would see what I mean.

You say this doc is salaried, doesn't gain anything from upcoding, and is stupid? Well then, defendant's motion to dismiss all fraud charges is granted, with prejudice.

The hospital's billing practices is another story, if what you say is true. Have you read your own contract? You're worrying about this other doc that you don't realize you are the one that's screwed if the hospital makes billing mistakes, let alone fraud. Hospital employment contracts always state that you allow the hospital to bill on your behalf. Plus, they will slip in a clause requiring you to indemnify the hospital if any payments are clawed back. Have you actually verified how The Man is billing your encounters accurately? Probably not.

Anyway, one of the annoying things about this specialty is psychiatrists love to get on their high horse and negatively judge other psychiatrists, in addition to the nonsense of getting pooped on by everyone else (patients, families, therapists, nurses, social workers, NPs, admin). I wish I had a dollar for every time someone slandered a psychiatrist.

 

[Trismegistus4]

You're thinking about this the wrong way man.
"This guy is dumb" doesn't equal fraud.
You seeing some notes this guy wrote that seem upcoded doesn't equal fraud.
If there's no financial incentive to do this that makes it even more UNLIKELY anyone would think this is fraud.

You need to have persistent hard large amounts of evidence that this person is intentionally billing for services he didn't provide. Even the upcoding thing can be explained away....you know how many psychiatrists I still see on facebook groups that can't figure out the difference between time based and complexity based billing? "Oops guess I misunderstood what the billing department told me sorry" is an extremely easy way to explain this away.

Ok, that's the kind of thing I need to know then. That's why I'm asking the question. If it has to be intentional to be fraud, then this would not in fact go anywhere.

This stuff happens fairly regularly actually. There is a local hospital chain where one of the psychiatrists was beating out all the neurosurgeons in RVUs the one year I saw the data, he was close to 13,000. Now I've cared for many of his patients and it's clear how he gets there, he has a real reputation for his practice style. I imagine he might be bending minutes a bit, but he does in fact see a metric ton of patients day-in and day-out and it's certainly not overt fraud.

I believe you, but that's not what happening here. We're all seeing the same number of patients.

 

[psydocc]

It's an inpatient gig. The person spends maybe 1 hours tops rounding on 12-14 patients (including new admissions,) copies forward yesterday's note, and leaves at noon.

Reminds me of this guy's story:

Doctor who once ran Arkansas medical board arrested for alleged Medicaid fraud

More than 40 ex-patients have also accused Dr. Brian Hyatt in civil suits of imprisoning them against their will.

www.nbcnews.com

"the attorney general’s office used video from 40 security cameras to track Hyatt’s time over 46 days in the unit and found that he spent 70% of his time in his office and just less than 1% seeing patients, or less than 10 minutes."

 

[Trismegistus4]

Reminds me of this guy's story:

Doctor who once ran Arkansas medical board arrested for alleged Medicaid fraud

More than 40 ex-patients have also accused Dr. Brian Hyatt in civil suits of imprisoning them against their will.

www.nbcnews.com

"the attorney general’s office used video from 40 security cameras to track Hyatt’s time over 46 days in the unit and found that he spent 70% of his time in his office and just less than 1% seeing patients, or less than 10 minutes."

LOL.

The person I am referring to also definitely keeps patients in the hospital longer than they need to be out of laziness. I keep hoping some patient or family will sue.

 

[psych_0]

If it's inpatient, most of them really are high MDM. If they aren't, they should be being discharged. It's not hard at all to make the MDM max level on IP. If someone is putting time statements in their notes that are excessive, my guess is the hospital billers told them they had to.

In a 5-day psychosis admission, days 2-4 are really almost the same progress note. If you manage to put in variety, then good for you.

I'm more concerned that this person wants to report the psychiatrist instead of having a conversation with the psychiatrist. Maybe they'd learn something!

This could not be any more accurate. 12 patients in 1 hour on a truly acute unit is not difficult to do at all.

dropping time-based/psychotherapy statements into notes stating that they spent 30 minutes face-to-face with a patient when they spent nowhere near that long

Are they just using those statements in a template, or are they actually adding additional psychotherapy add-on codes for extra wRVU? Those are two different things. No one that I know bills based on time, only high MDM to justify 99233. This is also not hard to justify at all.

 

[Crayola227]

I don't know what it is, but there is something about getting The Man or Authorities involved that often seems to backfire.

Totally tangential but the principle is this story. My neighbor wanted to sell her house for top dollar, so she can buy a cheaper house closer to her family, and have money to retire.

Her neighbor was running an automotive side business out of his property (a handful of cars, minor work, pretty quiet but yes there were quite a few cars). We're out in the country, not zoned for it, but also being in the country, the lots are big and people just kinda do their thing and it doesn't hurt anyone. Anyway, she doesn't like it because it's an eyesore to her. She's always trying to regulate on people around her like this. She was a juvenile detention officer but I digress.

So she called the county out on her neighbor, hoping to shut it down and in her view raise her property value. County comes out to investigate. They told the guy he couldn't have the business and as a result he couldn't have more than x number of cars there at a time.

But as part of their investigation, the most important thing they wanted to know was, where are you disposing of the motor oil? Major environmental issue. He could have been in a lot of trouble. But he had receipts from the neighbors lady's late husband, apparently he would pay that guy to take the oil, ostensibly to dispose of it properly. But what the late husband accepted to take it away was not what it costs to take dispose of it at any facility. The auto guy didn't get in trouble here because he had receipts and you could argue good faith, or at least you couldn't prove bad faith. But it did seem fishy the late husband would take oil for less than it would cost to properly dispose.

But there the paper trail stopped. Neighbor lady couldn't provide any proof her late husband took it to any facility. So the county starts investigating her property, and finds that all that oil he was paid to take, he dumped in the backyard and pocketed the cash so he'd have his own pocket money. Probably for booze to drink behind her back (My dad was friendly with the dude before he passed, and he would mention doing things like that behind her back).

So the county determines that her property is going to need tens of thousands of dollars, maybe even over $100,000, in hazmat work to be sellable. So she can't afford to move closer to family or retire. So she's trapped with her home farther from family, and at 82 still cleaning houses to make ends meet.

To boot, while the county was out, they saw that she had a shed that was too large to be there without permits. She was given 30 days to rectify or face $1000 a day fines. So she had to bother with tearing it down, paying for permits plus penalties for not having them to begin with, or what she did end up doing, which was pay to have it cut in half into 2 smaller legal buildings.

Someone else kind of got at the moral of this story earlier. The issue with getting authorities involved is that they're not like a dog that you just sicc on someone. There's no loyalty or favoritism, they just come in and notice anything they're not going to just ignore it because you're the one that called. You might have escaped their notice but once they show up, they see what they see.

And before you say, well I follow all the rules, like someone else alluded to, you don't know what you don't know. Just like the lady in the story.

Now I'm not saying you ignore ethics. But if it's not egregious, intentional, or directly harming patients, AND difficult to prove, I see nothing to gain here. What's more, in such a situation with an idiot, shouldn't you be more worried about patient care? If an intervention like making a report is unlikely to provide benefit, then instituting it can only expose you to harms, whatever they may be.

I don't know there are so many things in life to dedicate your time to making the world actually a better place. Mind your own business.

 

[Merovinge]

Reminds me of this guy's story:

Doctor who once ran Arkansas medical board arrested for alleged Medicaid fraud

More than 40 ex-patients have also accused Dr. Brian Hyatt in civil suits of imprisoning them against their will.

www.nbcnews.com

"the attorney general’s office used video from 40 security cameras to track Hyatt’s time over 46 days in the unit and found that he spent 70% of his time in his office and just less than 1% seeing patients, or less than 10 minutes."

The "efficient" psychiatrists I have known that round on 50+ patients/day at least have the decency to have the patient's assembly lined through their office so that they have clearly laid eyes on each one and have had a "conversation". They also don't bill time based psychotherapy codes. When greed takes over and we have people like that doc it's bad for the patient, but it's also bad for the profession and mental health treatment generally.

 

[Trismegistus4]

This could not be any more accurate. 12 patients in 1 hour on a truly acute unit is not difficult to do at all.



Are they just using those statements in a template, or are they actually adding additional psychotherapy add-on codes for extra wRVU? Those are two different things. No one that I know bills based on time, only high MDM to justify 99233. This is also not hard to justify at all.

Actually adding psychotherapy add-on codes.

Now I'm not saying you ignore ethics. But if it's not egregious, intentional, or directly harming patients, AND difficult to prove, I see nothing to gain here. What's more, in such a situation with an idiot, shouldn't you be more worried about patient care? If an intervention like making a report is unlikely to provide benefit, then instituting it can only expose you to harms, whatever they may be.

I don't know there are so many things in life to dedicate your time to making the world actually a better place. Mind your own business.

I believe it is egregious and directly harming patients. I have grave concerns about this person's basic competency.

I just took over a patient recently this person previously saw. This person did the H&P on this patient this hospitalization, and also happens to have done the H&P on this patient during a previous hospitalization last year. This time, instead of doing an actual H&P, this person "did" the H&P by copying forward their own H&P from last year. This copied-forward H&P contained a paragraph of collateral information obtained by a social worker at that time (last year) which included a statement by the patient's family that "he takes medication X." Apparently on that basis, this person restarted medication X this hospitalization, when the patient was already on another oral antipsychotic, and also didn't bother finding out that the patient received a long-acting injectable less than a month ago. So I take over the patient and he's essentially getting three antipsychotics, and is having parkinsonian side-effects.

Then, as if the copied-forward H&P wasn't bad enough, I read the progress notes and see that they contain statements about the patient's current presentation and treatment that are totally incorrect. So I do chart review and, sure enough, this person "did" their first progress note this hospitalization by copying forward a progress note of theirs from the patient's previous hospitalization, and just left those statements about the patient's presentation and treatment last year in there. Then copied forward the same note every day this hospitalization. So that large swaths of the progress note every day literally says "patient is being treated for condition Y" and "patient is receiving medication Z" when those statements are totally false. They are just carbon copies of notes from a different hospitalization last year!

Do you not believe such behavior should be cause for disciplinary action?

 

[Trismegistus4]

This could not be any more accurate. 12 patients in 1 hour on a truly acute unit is not difficult to do at all.

Also, forgot to add, it's never 12 floridly psychotic disorganized patients you can't have a conversation with. Plus, it's not always a 30 minute time statement. I have seen notes in which this person dropped an 80 or 90 minute time statement (and yes, it literally does say "I spent 90 minutes face-to-face with the patient" for one patient when the person didn't even spend 90 minutes total on the unit.)

 

[Crayola227]

Actually adding psychotherapy add-on codes.

I believe it is egregious and directly harming patients. I have grave concerns about this person's basic competency.

I just took over a patient recently this person previously saw. This person did the H&P on this patient this hospitalization, and also happens to have done the H&P on this patient during a previous hospitalization last year. This time, instead of doing an actual H&P, this person "did" the H&P by copying forward their own H&P from last year. This copied-forward H&P contained a paragraph of collateral information obtained by a social worker at that time (last year) which included a statement by the patient's family that "he takes medication X." Apparently on that basis, this person restarted medication X this hospitalization, when the patient was already on another oral antipsychotic, and also didn't bother finding out that the patient received a long-acting injectable less than a month ago. So I take over the patient and he's essentially getting three antipsychotics, and is having parkinsonian side-effects.

Then, as if the copied-forward H&P wasn't bad enough, I read the progress notes and see that they contain statements about the patient's current presentation and treatment that are totally incorrect. So I do chart review and, sure enough, this person "did" their first progress note this hospitalization by copying forward a progress note of theirs from the patient's previous hospitalization, and just left those statements about the patient's presentation and treatment last year in there. Then copied forward the same note every day this hospitalization. So that large swaths of the progress note every day literally says "patient is being treated for condition Y" and "patient is receiving medication Z" when those statements are totally false. They are just carbon copies of notes from a different hospitalization last year!

Do you not believe such behavior should be cause for disciplinary action?

You should always lead with patient care concerns and poor documentation that negatively impacts it, vs "fraud" in the form of uncoding and time spent for a salaried person where it is difficult to prove. You'll get more traction in any situation.

 

[Crayola227]

Let's say you knew of a doctor who was routinely documenting things they didn't do (i.e., dropping time-based/psychotherapy statements into notes stating that they spent 30 minutes face-to-face with a patient when they spent nowhere near that long) and billing the highest level billing code on every encounter despite spending almost zero time with patients and putting no effort into anything.

Would reporting them to Medicare/the state/some other agency likely result in any action being taken?

Purely hypothetically speaking, of course.

This initial post didn't make patients being at risk explicit. This makes it seem like the beef isn't that the care is poor, but that the documentation just doesn't accurately reflect time spent. Those are not synonymous, ie care can be appropriate even if the note doesn't accurately reflect time spent, it could otherwise be fine.

It just seems odd to me you led with the money issue and not the patient care issue.

Keep that in mind if you do want to make a report. Somehow this wasn't clear. If I was investigating it would be weird to me. I've just seen it unfold in medicine where someone begins with some otherwise benign error to fault a physician, and it's seemingly an afterthought or only later that patient care concerns are raised. And I've seen it being used more as a result of political issues in that case.

I'm not saying that's you, but if the progression of reporting on this doc goes "his documents are wrong and he's committing fraud!" And it gets the lukewarm response it did here, and THEN you say, "But danger to patients!" It naturally raises the question why you led with the first and not the second. It has the appearance of upping the ante because a lesser charge didn't get the reaction you wanted.
I could continue to expound why this seems fishy, but I'm sure people here can understand what I'm saying is concerning about this kind of reporting.

Of course, physicians might want scrutiny on a doc for the one issue and not raise the specter of patient care concerns directly, because we often hesitate to hurt another physician that way, even when warranted.

Lastly, have you tried either directly confronting this colleague about these errors in patients you share, or bringing your concerns to leadership? Because that seems the appropriate avenue, not trying to get them for medicare fraud.

 

[Trismegistus4]

You should always lead with patient care concerns and poor documentation that negatively impacts it, vs "fraud" in the form of uncoding and time spent for a salaried person where it is difficult to prove. You'll get more traction in any situation.

This initial post didn't make patients being at risk explicit. This makes it seem like the beef isn't that the care is poor, but that the documentation just doesn't accurately reflect time spent. Those are not synonymous, ie care can be appropriate even if the note doesn't accurately reflect time spent it could otherwise be fine.

I hear you. To be honest, the reason I started with the fraud angle is as follows: I believe 1) this person is not fixable, the only solution to this situation is for them to be fired, and that this should happen, but 2) hospital leadership is not going to do anything about it; psychiatrists here seem to be able to get away with doing whatever they want/not doing whatever they don't want and there are never any consequences. So, maybe I'm being overly pessimistic, but patient care, documentation, and other ethical concerns would be things that would be reported internally, and I just don't believe those complaints would ever go anywhere or lead to any action being taken. Whereas if the person got banned from Medicare/insurance panels, and/or got criminally convicted of fraud, and/or lost their license, etc. they simply would not be able to see patients and generate billing and therefore the hospital would have no choice but to let them go.

If the fraud angle is a dead end, though, then it's a dead end.

 

[Bartelby]

I often don't report about these things, but some responses here seem to fall into the "mind your own business" camp re: at least the upcoding as if it isn't really harming anyone. I disagree.

If someone is (for example) seeing 12 patients in 1 hour and billing a therapy add-on for each one, that would amount to an absolute minimum of 160 minutes of psychotherapy presuming they did nothing else the entire time. That's obviously not possible, and it's not even close. And almost certainly they do no more than a minute or two of "therapy" for each patient.

I personally would want to avoid the potential professional backlash of reporting on a colleague because local psychiatry is a small world and it may very well cause you lots of headaches, but I actually would like to see these most egregious examples stopped. If we don't check this kind of behavior as a field, eventually such codes will probably just be viewed as a scam and payment will be much reduced or discontinued. That means those of us who are actually doing the work we are coding for then have to either take a big income hit or race to the bottom to keep up reasonable productivity metrics.

I don't think anyone should be going to prison or losing their license over just upcoding, but it would be nice for the worst offenders to get reigned in. But of course, as others have said, if you don't have any proof then such a claim probably will not go anywhere (but can still blow up in your face for having brought it!).

 

[Crayola227]

I hear you. To be honest, the reason I started with the fraud angle is as follows: I believe 1) this person is not fixable, the only solution to this situation is for them to be fired, and that this should happen, but 2) hospital leadership is not going to do anything about it; psychiatrists here seem to be able to get away with doing whatever they want/not doing whatever they don't want and there are never any consequences. So, maybe I'm being overly pessimistic, but patient care, documentation, and other ethical concerns would be things that would be reported internally, and I just don't believe those complaints would ever go anywhere or lead to any action being taken. Whereas if the person got banned from Medicare/insurance panels, and/or got criminally convicted of fraud, and/or lost their license, etc. they simply would not be able to see patients and generate billing and therefore the hospital would have no choice but to let them go.

If the fraud angle is a dead end, though, then it's a dead end.

This makes a ton of sense.

 

[Crayola227]

I personally would want to avoid the potential professional backlash of reporting on a colleague because local psychiatry is a small world and it may very well cause you lots of headaches, but I actually would like to see these most egregious examples stopped.

Sounds like the mafia. The way physicians shield each other or feel like they can't speak out. Bad implications for care.

 

[ObsequiousAplomb]

Actually adding psychotherapy add-on codes.

I believe it is egregious and directly harming patients. I have grave concerns about this person's basic competency.

I just took over a patient recently this person previously saw. This person did the H&P on this patient this hospitalization, and also happens to have done the H&P on this patient during a previous hospitalization last year. This time, instead of doing an actual H&P, this person "did" the H&P by copying forward their own H&P from last year. This copied-forward H&P contained a paragraph of collateral information obtained by a social worker at that time (last year) which included a statement by the patient's family that "he takes medication X." Apparently on that basis, this person restarted medication X this hospitalization, when the patient was already on another oral antipsychotic, and also didn't bother finding out that the patient received a long-acting injectable less than a month ago. So I take over the patient and he's essentially getting three antipsychotics, and is having parkinsonian side-effects.

Then, as if the copied-forward H&P wasn't bad enough, I read the progress notes and see that they contain statements about the patient's current presentation and treatment that are totally incorrect. So I do chart review and, sure enough, this person "did" their first progress note this hospitalization by copying forward a progress note of theirs from the patient's previous hospitalization, and just left those statements about the patient's presentation and treatment last year in there. Then copied forward the same note every day this hospitalization. So that large swaths of the progress note every day literally says "patient is being treated for condition Y" and "patient is receiving medication Z" when those statements are totally false. They are just carbon copies of notes from a different hospitalization last year!

Do you not believe such behavior should be cause for disciplinary action?

While I try to avoid doing this, I have to admit I've seen many colleagues do this, and I've seen it done on an institutional scale rather frequently in my short career. Did you not get exposure to people like this earlier in your career? How is this so surprising to you?

 

[Trismegistus4]

While I try to avoid doing this, I have to admit I've seen many colleagues do this, and I've seen it done on an institutional scale rather frequently in my short career. Did you not get exposure to people like this earlier in your career? How is this so surprising to you?

No, I don't recall seeing anything so egregious before.

 

[TexasPhysician]

With providing more details:

I’d be more concerned about admin protecting the facility if you bring this up, but that would be a good first step to create change. I’d set a meeting with higher-ups wanting to discuss a significant patient care issue. I’d ask that they bring the last few admission charts for Patient X. This way they are bringing the chart to you. I’d then show how notes are copied forward exactly. This is a patient care issue and potentially fraud if on a larger scale. I’d voice that I enjoy working at the facility, and I don’t want my favorite job to be harmed because someone else is making poor decisions. While this is the most recent example, I would also be ready with a few other names to prove this isn’t a 1x failure. I wish to protect the company (not get fired for knowing too much). This would be a good way to start improving patient care. The facility will either need to investigate and either force change or terminate said employee or you. Unfortunately facilities have been known to protect their revenue streams and could always terminate you for knowing too much. They don’t want you accumulating enough evidence to develop a bigger issue.

If you wanted to report for Medicare fraud, you need a lot of evidence. 5 examples isn’t worth their time to investigate. I’d recommend starting with at least 50 Medicare patient names, DOB, and at least a few chart examples that all involve clear fraud.

 

[Mad Jack]

With providing more details:

I’d be more concerned about admin protecting the facility if you bring this up, but that would be a good first step to create change. I’d set a meeting with higher-ups wanting to discuss a significant patient care issue. I’d ask that they bring the last few admission charts for Patient X. This way they are bringing the chart to you. I’d then show how notes are copied forward exactly. This is a patient care issue and potentially fraud if on a larger scale. I’d voice that I enjoy working at the facility, and I don’t want my favorite job to be harmed because someone else is making poor decisions. While this is the most recent example, I would also be ready with a few other names to prove this isn’t a 1x failure. I wish to protect the company (not get fired for knowing too much). This would be a good way to start improving patient care. The facility will either need to investigate and either force change or terminate said employee or you. Unfortunately facilities have been known to protect their revenue streams and could always terminate you for knowing too much. They don’t want you accumulating enough evidence to develop a bigger issue.

If you wanted to report for Medicare fraud, you need a lot of evidence. 5 examples isn’t worth their time to investigate. I’d recommend starting with at least 50 Medicare patient names, DOB, and at least a few chart examples that all involve clear fraud.

The problem you run with this is the potential risk for retaliation, such as the organization asking why you were accessing and providing information for patients that you had not provided direct patient care for. The kind of organization that enables bad doctors is exactly the sort that will go after good doctors when they file reports to avoid owning up to the previous behavior they have enabled. It's easier to blame one person than to say your whole organization's priorities need to change

 

[Geraltofrivia]

Snitches are whack

 

[Crayola227]

The problem you run with this is the potential risk for retaliation, such as the organization asking why you were accessing and providing information for patients that you had not provided direct patient care for. The kind of organization that enables bad doctors is exactly the sort that will go after good doctors when they file reports to avoid owning up to the previous behavior they have enabled. It's easier to blame one person than to say your whole organization's priorities need to change

I guess the real issue is that they do in fact share patients so this physician directly cares for these same patients in the same setting. Still not entirely clear why they would go the fraud route rather than the real issue

 

[Crayola227]

I hear you. To be honest, the reason I started with the fraud angle is as follows: I believe 1) this person is not fixable, the only solution to this situation is for them to be fired, and that this should happen, but 2) hospital leadership is not going to do anything about it; psychiatrists here seem to be able to get away with doing whatever they want/not doing whatever they don't want and there are never any consequences. So, maybe I'm being overly pessimistic, but patient care, documentation, and other ethical concerns would be things that would be reported internally, and I just don't believe those complaints would ever go anywhere or lead to any action being taken. Whereas if the person got banned from Medicare/insurance panels, and/or got criminally convicted of fraud, and/or lost their license, etc. they simply would not be able to see patients and generate billing and therefore the hospital would have no choice but to let them go.

If the fraud angle is a dead end, though, then it's a dead end.

Ah, yes, this was why. Afraid the institution wouldn't act on an unfixable individual. Why has no one suggested a report to the board if there really is patient safety issue? They will at least have to nominally respond. The example of the patient receiving 3 meds and the wrong one due to that kind of copy pasta pure laziness seems pretty bad. Of course we already made the argument psych is a small world and blowback, but this seems like it would be the more proper avenue to go besides the fraud issues.

 

[Ceke2002]

Sounds like the mafia. The way physicians shield each other or feel like they can't speak out. Bad implications for care.

Off topic to the OP's question, but this is exactly what was happening in my home town in the 80s and 90s. There was a group of about 5 Doctors back then, all from different specialties, all dodgy as eff, all of them used to back each other up. It also didn't help that they primarily worked with disadvantaged communities who were way less likely to be believed or taken seriously if they did try to bring a complaint against any of them.

 

[Trismegistus4]

Snitches are whack

It's extremely demoralizing to work in an environment where you're trying to do a good job, be a conscientious doctor, and do what's best for your patients, and there are others who shamelessly express that they feel entitled to essentially fake doing the job and shirk as much responsibility as possible, and get paid the same.

 

[Candidate2017]

It's extremely demoralizing to work in an environment where you're trying to do a good job, be a conscientious doctor, and do what's best for your patients, and there are others who shamelessly express that they feel entitled to essentially fake doing the job and shirk as much responsibility as possible, and get paid the same.

I hear you. I, too, am demoralized by those in healthcare who fake doing medicine and shirk responsibility:

Midlevels who do 1/10th of the thinking and 1/4th of the work, but get paid 1/3rd of what psychiatrists make.
Hospital and insurance CEOs who do none of thinking and none of the work, but get paid 70 times what psychiatrists make.

 

[Merovinge]

It's extremely demoralizing to work in an environment where you're trying to do a good job, be a conscientious doctor, and do what's best for your patients, and there are others who shamelessly express that they feel entitled to essentially fake doing the job and shirk as much responsibility as possible, and get paid the same.

In my experience the ones doing that actually make more money as they can "see" more patients (to add the next layer of salt to the wound).

 

[Trismegistus4]

I hear you. I, too, am demoralized by those in healthcare who fake doing medicine and shirk responsibility:

Midlevels who do 1/10th of the thinking and 1/4th of the work, but get paid 1/3rd of what psychiatrists make.
Hospital and insurance CEOs who do none of thinking and none of the work, but get paid 70 times what psychiatrists make.

I'm not happy about those things either, but they have nothing to do with this situation.

It seems your instinct is to circle the wagons around any fellow "doctor." I can't give too many details, but I guarantee that if you could be in the same room as this person for 10 seconds, you would be putting "doctor" in scare quotes too. As soon as they opened their mouth, your first thought, as was mine, would be "there is simply no way this person could possibly pass the USMLE steps."

 

[Stagg737]

I believe it is egregious and directly harming patients. I have grave concerns about this person's basic competency.

I just took over a patient recently this person previously saw. This person did the H&P on this patient this hospitalization, and also happens to have done the H&P on this patient during a previous hospitalization last year. This time, instead of doing an actual H&P, this person "did" the H&P by copying forward their own H&P from last year. This copied-forward H&P contained a paragraph of collateral information obtained by a social worker at that time (last year) which included a statement by the patient's family that "he takes medication X." Apparently on that basis, this person restarted medication X this hospitalization, when the patient was already on another oral antipsychotic, and also didn't bother finding out that the patient received a long-acting injectable less than a month ago. So I take over the patient and he's essentially getting three antipsychotics, and is having parkinsonian side-effects.

Then, as if the copied-forward H&P wasn't bad enough, I read the progress notes and see that they contain statements about the patient's current presentation and treatment that are totally incorrect. So I do chart review and, sure enough, this person "did" their first progress note this hospitalization by copying forward a progress note of theirs from the patient's previous hospitalization, and just left those statements about the patient's presentation and treatment last year in there. Then copied forward the same note every day this hospitalization. So that large swaths of the progress note every day literally says "patient is being treated for condition Y" and "patient is receiving medication Z" when those statements are totally false. They are just carbon copies of notes from a different hospitalization last year!

Do you not believe such behavior should be cause for disciplinary action?

So I generally don't report unless it's something truly egregious, but this is truly egregious AND YOU HAVE THE DOCUMENTATION TO BACK IT UP!

Copying forward notes from a year earlier without editing them at all when they are blatantly incorrect is fraud. Period. Doing so for multiple notes in a stay is just crazy. The fact that they are now ordering different meds that don't align with the notes is also something that can be easily proven as well. If this doc is doing this with CMS patients, start keeping tabs. When you've got enough examples (idk how many is "enough", I would think 10-20, but if it's as common as you say 40-50 should be doable) then report it. You can even include the order logs and show that meds are being administered that don't line up with documentation. Just be aware as others have said that by doing this you're putting your job at risk and you need to be prepared to walk. That said, if the gov finds there's fraud and goes forward then they'll charge $10-20k/incident and the whistleblower can get something like 10-25% of that as Splik mentioned, so maybe you'll get to FatFIRE early, lol.

Either way, this sounds bad enough to report it. I hear the people saying to be cautious, but it's this kind of jacka$$ery that gives everyone in our field an awful reputation. Or standard of care in psych is pathetically low but it exists. Letting crap like this slide is exactly how we win the race to the bottom.

 

[VA Hopeful Dr]

So I generally don't report unless it's something truly egregious, but this is truly egregious AND YOU HAVE THE DOCUMENTATION TO BACK IT UP!

Copying forward notes from a year earlier without editing them at all when they are blatantly incorrect is fraud. Period. Doing so for multiple notes in a stay is just crazy. The fact that they are now ordering different meds that don't align with the notes is also something that can be easily proven as well. If this doc is doing this with CMS patients, start keeping tabs. When you've got enough examples (idk how many is "enough", I would think 10-20, but if it's as common as you say 40-50 should be doable) then report it. You can even include the order logs and show that meds are being administered that don't line up with documentation. Just be aware as others have said that by doing this you're putting your job at risk and you need to be prepared to walk. That said, if the gov finds there's fraud and goes forward then they'll charge $10-20k/incident and the whistleblower can get something like 10-25% of that as Splik mentioned, so maybe you'll get to FatFIRE early, lol.

Either way, this sounds bad enough to report it. I hear the people saying to be cautious, but it's this kind of jacka$$ery that gives everyone in our field an awful reputation. Or standard of care in psych is pathetically low but it exists. Letting crap like this slide is exactly how we win the race to the bottom.

You have to be careful with this. I use lots of smart phrases in epic that, for stable patients, look like I just copy the notes from one visit to another. I don't, and in fact all of my smart phrases have multiple fields that I select from. But if a patient I'm seeing for say GERD has had no symptoms while taking his Nexium for the last 3 years then each time I write the note it will look like I copied it from the previous note. That's not what happens, but I ask the exact same questions every time and if the answers don't change then the note doesn't change.

 

[Stagg737]

You have to be careful with this. I use lots of smart phrases in epic that, for stable patients, look like I just copy the notes from one visit to another. I don't, and in fact all of my smart phrases have multiple fields that I select from. But if a patient I'm seeing for say GERD has had no symptoms while taking his Nexium for the last 3 years then each time I write the note it will look like I copied it from the previous note. That's not what happens, but I ask the exact same questions every time and if the answers don't change then the note doesn't change.

Sure, but there are easy ways to see if that's what's happening. A lot of EMRs now have buttons built in to see what has copied forward and what is new text. Where I'm at it's an easy way to see what residents are actually doing before I cosign their notes. I'm also sure there will be variances in the HPI in terms of the order you use smart phrases, and unless someone is totally stable (in which case why the f would they be admitted to inpatient psych?) you're going to be adding and taking out symptoms that are or aren't relevant.

That's definitely not what's happening in OP's description where the person is copying forward the entire note, with the events that led to the admission a year earlier which were totally different circumstances as now, and the person isn't updating med changes which are completely different from a year earlier. We're not talking about using the same smart phrases which I agree is completely fine. We're talking about lying and provably false documentation due to laziness which is straight up fraud when billing CMS. Frankly I'd also consider reporting this doc to the state medical board also as in OP's example it's directly causing patient harm.

 

[Merovinge]

Sure, but there are easy ways to see if that's what's happening. A lot of EMRs now have buttons built in to see what has copied forward and what is new text. Where I'm at it's an easy way to see what residents are actually doing before I cosign their notes. I'm also sure there will be variances in the HPI in terms of the order you use smart phrases, and unless someone is totally stable (in which case why the f would they be admitted to inpatient psych?) you're going to be adding and taking out symptoms that are or aren't relevant.

That's definitely not what's happening in OP's description where the person is copying forward the entire note, with the events that led to the admission a year earlier which were totally different circumstances as now, and the person isn't updating med changes which are completely different from a year earlier. We're not talking about using the same smart phrases which I agree is completely fine. We're talking about lying and provably false documentation due to laziness which is straight up fraud when billing CMS. Frankly I'd also consider reporting this doc to the state medical board also as in OP's example it's directly causing patient harm.

I've seen this same thing in other fields as well where docs are copying old notes from year(s) back that are wildly inaccurate. It's actually comical to see if it wasn't so depressing. There's an old doc I know who is well past retirement age that doesn't take any new patients and does this for all of his panel, he might change a few words in the plan if there is something really new.

 

[Geraltofrivia]

I'm not happy about those things either, but they have nothing to do with this situation.

It seems your instinct is to circle the wagons around any fellow "doctor." I can't give too many details, but I guarantee that if you could be in the same room as this person for 10 seconds, you would be putting "doctor" in scare quotes too. As soon as they opened their mouth, your first thought, as was mine, would be "there is simply no way this person could possibly pass the USMLE steps."

Why have you not gone towards the institution? Does your director know about this? If yes, what about the CMO? Are you in New York? That's what I would do before going to the board, or some oversight agency such as OPMC

 

[Trismegistus4]

You have to be careful with this. I use lots of smart phrases in epic that, for stable patients, look like I just copy the notes from one visit to another. I don't, and in fact all of my smart phrases have multiple fields that I select from. But if a patient I'm seeing for say GERD has had no symptoms while taking his Nexium for the last 3 years then each time I write the note it will look like I copied it from the previous note. That's not what happens, but I ask the exact same questions every time and if the answers don't change then the note doesn't change.

I know what you mean, but as @Stagg737 points out, that's not what's happening here.

This person is basically too lazy to do notes in any real sense. 99% of the content of their notes is just 1) copied-forward/copied-pasted text from somebody else's note, and 2) their own smartphrases/copy-paste phrases, but used so commonly and indiscriminately that if you've read many of this person's charts, you have no confidence that the particular phrases being used actually apply in that situation.

For example, this person has a stock phrase they use in their HPI that is something like "Patient admits to noncompliance with outpatient regimen." But they will put this phrase in their H&P on a patient for who had not in fact been prescribed an outpatient regimen. Or, wanting to justify using a long-acting injectable antipsychotic, they have a stock phrase that is something like "Patient has a history of repeated rehospitalization due to noncompliance with oral antipsychotic." But they will put this phrase in a note on a patient who has never had a psychiatric admission before. The statement that the patient has a history of repeated hospitalization is a bald-faced lie.

There is never a time that this person actually writes a real note like "Patient describes worsening depressive symptoms over the past 2 weeks in the setting of the encroaching anniversary of her mother's death. She has had low mood, anhedonia, difficulty sleeping, fatigue, diminished appetite, and poor concentration. She denies suicidal thoughts, but admits that she frequently thinks she would not mind if she went to sleep and didn't wake up. At times she has heard a voice calling her name. She had a similar episode a year and a half ago, at which time her PCP started her on sertraline 50 mg. She found it effective for these symptoms at first, but more recently they have returned." They never write or dictate a narrative like that. Instead, their HPI is one brief paragraph consisting of 3-4 of their same stock/boilerplate sentences they use for almost every patient, and the rest copied/pasted verbatim from ED and consult notes (where people did do a narrative.)

Also, this person avoids doing the first progress note of a hospitalization (i.e., the patient's second day,) because that entails building a progress note from scratch instead of copying one forward. So they will have the midlevel see the patient, who will write something like "Patient seen this morning on rounds. He reports he was nervous about attending groups at first, but attended one yesterday afternoon and found it helpful. Wife visited yesterday evening; they had a good visit and he feels his wife is supportive. Reports his mood is still down, but not having any suicidal thoughts today. Took the first dose of Abilify yesterday and noted no side effects. He is starting to be able to identify activities he looks forward to upon going home, like tending his garden."

Then the next day, this person will do their progress by copying forward the midlevel's, and leave the subjective section totally unchanged. The subjective section will literally be that exact paragraph above, with nothing added or changed. Then they will continue to copy that forward for days, so that for several days in a row, that exact paragraph is the subjective section of each day's progress note. Again, with nothing added or modified.

And I think what's so galling about this is that I feel like all through med school and residency, we were taught that the absolute worst thing you could possibly do is to put false information in your note, with one subset of that being the infamous "documenting that you did things you didn't do." We had it drilled into us that if you did that, you were with 100% certainly going to be successfully sued, potentially lose your license, possibly even get criminally convicted of fraud. Yet this person has just been brazenly getting away with this for years, with nobody saying or doing anything about it.

I've seen this same thing in other fields as well where docs are copying old notes from year(s) back that are wildly inaccurate. It's actually comical to see if it wasn't so depressing. There's an old doc I know who is well past retirement age that doesn't take any new patients and does this for all of his panel, he might change a few words in the plan if there is something really new.

In addition to the poor documentation, this person routinely reveals such poor understanding of diagnostics and treatment that it would be almost comical if it weren't so bad for patient care. As I keep saying, if you could hear this person talk, you would know what I mean. You would be shocked to see some of the treatment decisions, to overheard some of the comments about when this or that medication is indicated or contraindicated, etc. It's as though a very unintelligent but very cocky and self-assured layman overheard a few discussions about psychiatry and thought that a few words and phrases they plucked out of those discussions (without any real understanding) made them knowledgeable and qualified to practice psychiatry.

Why have you not gone towards the institution? Does your director know about this? If yes, what about the CMO? Are you in New York? That's what I would do before going to the board, or some oversight agency such as OPMC

I'm open to any suggestions. Maybe I jumped the gun by bringing up fraud right away. These are all good things to know about. Though no, I'm not in New York and as far as I can tell, my state doesn't have an OPMC, though I see from the medical board website there is a way to file a complaint there.

 

[Stagg737]

And I think what's so galling about this is that I feel like all through med school and residency, we were taught that the absolute worst thing you could possibly do is to put false information in your note, with one subset of that being the infamous "documenting that you did things you didn't do." We had it drilled into us that if you did that, you were with 100% certainly going to be successfully sued, potentially lose your license, possibly even get criminally convicted of fraud. Yet this person has just been brazenly getting away with this for years, with nobody saying or doing anything about it.

I mean, there's some hyperbole in this, but the sentiment is accurate.

You keep giving us more and more examples that this person is a danger to patients and practicing illegally. I'm not sure what else you want us to say, but if all of the above is true and something this individual is doing even doing somewhat regularly let alone all the time, you should report them. Just be aware that when you do your employer may retaliate. If they've been letting this fly without saying or doing anything for so long, this isn't somewhere I'd ever want to work anyway.

Like Splik mentioned, if the feds get involved, find this to be true, and decide to take action (which I can't imagine they wouldn't if this is as egregious and common as you're saying) you could get a decent sum out of this anyway.

 

[Trismegistus4]

I mean, there's some hyperbole in this, but the sentiment is accurate.

You keep giving us more and more examples that this person is a danger to patients and practicing illegally. I'm not sure what else you want us to say, but if all of the above is true and something this individual is doing even doing somewhat regularly let alone all the time, you should report them. Just be aware that when you do your employer may retaliate. If they've been letting this fly without saying or doing anything for so long, this isn't somewhere I'd ever want to work anyway.

Yeah, I get it. Sorry for coming across as just venting.

Like Splik mentioned, if the feds get involved, find this to be true, and decide to take action (which I can't imagine they wouldn't if this is as egregious and common as you're saying) you could get a decent sum out of this anyway.

This is true only if you blow the whistle to CMS and there is a finding of fraud, though. AFAIK, all these other concerns like ethics, professionalism, poor patient care, false documentation (that's not falsified specifically to commit fraud) wouldn't fall under that.