Navy Flight Surgeons Important Update

[backrow]

To all the Navy flight surgeons out there please be aware that a new policy has come down in regards to your flight pay.

Over the past few years rumors have been rampant regarding changes including one that said you would only get paid at the end of the year. That particular idea was dumped; however, there are some significant changes.

Beginning this Oct 1 you must submit through your Chain a letter to PERS that outlines how many hours you flew each month. That letter will then be taken and your flight pay will be recouped if you don't meet the requirements. Your pay will also be taken back if you don't submit the paperwork by December.

I don't have the instruction number on hand, but have read it, if I find the # I'll be sure to post.

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[OkiTodd]

Thank you for the head's up, look forward to reading the instruction once released.

 

[IgD]

Looks like the Navy Medicine belt tightening has begun

 

[backrow]

Looks like the Navy Medicine belt tightening has begun

Actually this is coming from higher than BUMED. The scuttlebut is that sometime in the last 5yrs or so they did an audit on flight pay and found many individuals who were receiving flight pay who did not rate it. Some were flight surgeons who weren't flying, but [rumor alert, rumor alert] the vast majority were former pilots/nfo's who had done a lateral transfer to another community and were still receiving it [end rumor alert]

Anyway, here's the link to the instruction.

http://doni.daps.dla.mil/Directives...rvices/07-200 Disbursing Services/7220.18.pdf

 

[Kris1]

I'm a PGY-1 in EM thinking about returning to the military for a bit post-residency. Does anyone know if I'm stationed CONUS and work for the base ER if I can moonlight on occasion at the community ER?

 

[SDN]

Yes, if your commander approves it.

 

[AF M4]

I'm a PGY-1 in EM thinking about returning to the military for a bit post-residency. Does anyone know if I'm stationed CONUS and work for the base ER if I can moonlight on occasion at the community ER?

Thread hijack in process...

It's not that simple.

For your moonlighting civilian gig you CANNOT see military or military dependents. This is called double-dipping, because the military is paying you a salary to see military patients at the military ER. The military will not pay the civilian hospital's bill if a military doctor saw a military patient at a civilian hospital.

This rule occurred because a bunch of military docs were goofing off during their day jobs and telling their military patients to just meet them downtown at the civilian hospital so that they could bill the military for their patient load while still collecting a full military salary.

Yes, this is fraud, and you can lose your license, your credentials and get some jail time if your infractions are particularly egregious.

 

[backrow]

A new navadmin came out in regards to this: we now have 60 days from the release of this message (9 sep) to get our flight hours sent to PERS.

http://www.npc.navy.mil/NR/rdonlyres/A0A68DCB-97F2-4303-863B-70AE732D87C0/0/NAV10301.txt

 

[Kris1]

Thread hijack in process...

It's not that simple.

For your moonlighting civilian gig you CANNOT see military or military dependents. This is called double-dipping, because the military is paying you a salary to see military patients at the military ER. The military will not pay the civilian hospital's bill if a military doctor saw a military patient at a civilian hospital.

This rule occurred because a bunch of military docs were goofing off during their day jobs and telling their military patients to just meet them downtown at the civilian hospital so that they could bill the military for their patient load while still collecting a full military salary.

Yes, this is fraud, and you can lose your license, your credentials and get some jail time if your infractions are particularly egregious.

Sorry about the thread hijack. I knew better and that wasn't intentional.

 

[orbitsurgMD]

Thread hijack in process...

It's not that simple.

For your moonlighting civilian gig you CANNOT see military or military dependents. This is called double-dipping, because the military is paying you a salary to see military patients at the military ER. The military will not pay the civilian hospital's bill if a military doctor saw a military patient at a civilian hospital.

This rule occurred because a bunch of military docs were goofing off during their day jobs and telling their military patients to just meet them downtown at the civilian hospital so that they could bill the military for their patient load while still collecting a full military salary.

Yes, this is fraud, and you can lose your license, your credentials and get some jail time if your infractions are particularly egregious.

I doubt this scare story has ever been tested in any real court. It is incredible how much life it still has, all the same.

First of all, dependents are as a matter of policy sent to civilian facilities. The military knows it has to pay for that care; that is also established policy. They aren't calling in from his home, Dr. (CDR) Joe Moonlighter, MC, to see ED overflow, so to argue that this doctor's off-duty time is somehow entirely the property of the U.S. government (mind you no one says he can't see Medicare patients and get paid, who do you think is paying for that?) is just plain laughable. Second, a military physician working during "off time" at a civilian facility cannot control where any patient may seek care, and certainly would not have sent the patient to a particular emergency room where he was working, uh, at the same time. Third, most ED groups bill under an NPI number different from the individual NPI number of the practitioner, so the likelihood of anyone "detecting" such an occurence is low. Fourth, the military would be expected to pay the billing party, regardless of where the doctor held any kind of outside employment, at a VA, another private hospital, or wherever. Lastly, there is no law that says a service member can't buy a share of a private medical enterprise that might somehow provide service to a Tricare beneficiary and thus render a dividend to that military shareholder, assuming there was no direct referral relationship that would violate existing Federal legislation (i.e., Stark II, etc.) So income received by a military member from a clinical encounter by a Tricare beneficiary is not illegal.

So I call B.S. on this hoary old tale of who you can't see and bill for care. Show me a case where a military doctor was ever successfully prosecuted (or for that matter, prosecuted period) for billing for treatment of a Tricare beneficiary seen while moonlighting during off-duty hours.

 

[Jet915]

A new navadmin came out in regards to this: we now have 60 days from the release of this message (9 sep) to get our flight hours sent to PERS.

http://www.npc.navy.mil/NR/rdonlyres/A0A68DCB-97F2-4303-863B-70AE732D87C0/0/NAV10301.txt

Reading the navadmin, anyone know the difference between continuous vs. conditional acip? Seems like if you are continuous, this does not apply.

 

[backrow]

Reading the navadmin, anyone know the difference between continuous vs. conditional acip? Seems like if you are continuous, this does not apply.

Continuous is for NFO's/Pilots. All flight surgeons/optometrists/physiologists are conditional.

Those who have continuous have to meet certain "gates" throughout their career to keep their pay; however, the first gate isn't until fairly well into their careers.

 

[AF M4]

I doubt this scare story has ever been tested in any real court. It is incredible how much life it still has, all the same.

First of all, dependents are as a matter of policy sent to civilian facilities. The military knows it has to pay for that care; that is also established policy. They aren't calling in from his home, Dr. (CDR) Joe Moonlighter, MC, to see ED overflow, so to argue that this doctor's off-duty time is somehow entirely the property of the U.S. government (mind you no one says he can't see Medicare patients and get paid, who do you think is paying for that?) is just plain laughable. Second, a military physician working during "off time" at a civilian facility cannot control where any patient may seek care, and certainly would not have sent the patient to a particular emergency room where he was working, uh, at the same time. Third, most ED groups bill under an NPI number different from the individual NPI number of the practitioner, so the likelihood of anyone "detecting" such an occurence is low. Fourth, the military would be expected to pay the billing party, regardless of where the doctor held any kind of outside employment, at a VA, another private hospital, or wherever. Lastly, there is no law that says a service member can't buy a share of a private medical enterprise that might somehow provide service to a Tricare beneficiary and thus render a dividend to that military shareholder, assuming there was no direct referral relationship that would violate existing Federal legislation (i.e., Stark II, etc.) So income received by a military member from a clinical encounter by a Tricare beneficiary is not illegal.

So I call B.S. on this hoary old tale of who you can't see and bill for care. Show me a case where a military doctor was ever successfully prosecuted (or for that matter, prosecuted period) for billing for treatment of a Tricare beneficiary seen while moonlighting during off-duty hours.

Ironically, a flight doc at my base got nailed for doing this at a civilian ER a year ago, which is why I know so much about this. He slipped under the radar for a couple of shifts, and the ER director was quite pissed when he discovered that Tricare had denied all the claims for reimbursement for the patients that he saw in that time period. He was fired from his civilian job after that, and no, he was not prosecuted. The ER did recoup his paycheck from those shifts however; the guy actually threatened to fight them for the $ but ended up backing down once they threatened to put some sort of black mark on his record.

I imagine that if it had gone undetected for a more significant period of time and then was finally detected, the ER would have lost a much more substantial sum and been more motivated to get their pound of flesh.

It's the law; it doesn't have to make sense for it to be enforced. All you need is a paragraph in the Tricare reimbursement policybook and a suddenly poor and very aggrieved civilian hospital to create some fireworks.

If you want to call BS and make a few extra bucks on the side, go right ahead and do it. But don't expect any sympathy afterwards.

 

[backrow]

anyone have $ taken away yet?

Not that I'm aware of. Interestingly enough in the latest email update from CNAF to flight surgeons it had a different due date, so may be a bit yet before some people get hit.

 

[pgg]

For your moonlighting civilian gig you CANNOT see military or military dependents. This is called double-dipping, because the military is paying you a salary to see military patients at the military ER. The military will not pay the civilian hospital's bill if a military doctor saw a military patient at a civilian hospital.

My command's moonlighting instruction requires the civilian employer to sign a statement acknowledging that they can not bill the government for any care I deliver to Tricare beneficiaries.

I'm sure some slip through the cracks and they submit claims to the government. I have no idea how many are paid vs rejected, but no one's ever said anything to me about it. It's not my problem if I do a case but the group doesn't get paid for it. When I'm on call, it's not like there's a backup guy who comes in to do the Tricare cases. Most of the time I don't even know the insurance status of my patients, nor do I care, because I get paid by the hour.

[...] to argue that this doctor's off-duty time is somehow entirely the property of the U.S. government (mind you no one says he can't see Medicare patients and get paid, who do you think is paying for that?) is just plain laughable.

Exactly. It's just Bit O' Insanity # 7,183 from the military. 99% of my moonlighting is weekends or leave when the military really has no honest claim to my labor. It makes my head spin.

 

[orbitsurgMD]

My command's moonlighting instruction requires the civilian employer to sign a statement acknowledging that they can not bill the government for any care I deliver to Tricare beneficiaries.

[Bolds mine]

Which begs the question: if the command has to ask for what amounts to a written agreement not to bill Tricare beneficiaries, exactly what is the supposed "law" that is on the books preventing that billing actually prohibiting?
Why is an agreement necessary?

Could it be possible that there actually is no such law? A black letter reference would be good. Could this so-called law have already been void?

 

[pgg]

[Bolds mine]

Which begs the question: if the command has to ask for what amounts to a written agreement not to bill Tricare beneficiaries, exactly what is the supposed "law" that is on the books preventing that billing actually prohibiting?
Why is an agreement necessary?

Could it be possible that there actually is no such law? A black letter reference would be good. Could this so-called law have already been void?

Even if there is a law, I have zero doubt that it could be challenged in court and struck down. But who's going to bother? The government's slavering lawyerly minions have deep pockets and endless time; the moonlighting doctors are invariably short timers who just add this bit of military stupidity to the list of things to put up with before they get out in a year or two. They're going to be civilians before the case is heard anyway.

The people it sort of hurts are the military doctors who moonlight, do their own billing, and find themselves involuntarily taking care of Tricare patients because they're "the guy" on call at a particular moment. I have to believe this is a small minority of cases for a small minority of doctors.

Even the one surgeon I know who moonlights and has a pseudo-eat-what-you-kill contract gets paid a stipend for taking call. So even when he does the Saturday ER case on the 60-year-old Tricare trauma patient, he's still getting something by way of a call stipend. He misses out on the Tricare (worse than MediCal) payment.


I guess the hypothetical (imaginary?) shady military doctors who refer their AD patients away from the MTF to their moonlighting gig to drum up cash business are the ones who really get hurt. But it seems to me that someone willing to pull that kind of ethical shenanigans would just have a partner or the group launder the billing.


The whole thing strikes me as the military's pointless handwaving unethical solution to a non-problem.

 

[backrow]

Even though this is now way off topic,

I believe the laws you guys are looking for are likely in the health insurance laws. My understanding is that a provider is not allowed to "double bill" for services rendered which is basically what is happening if a military doctor is billing for the care of a Tricare beneficiary.

I'm sure if you talked to your local Tricare office or your financial guru's at the hospital they could point you to the specific laws covering this issue.