Oregon pain clinic defrauding insurers

[Agast]

Oregon Medical Board Accuses Pain Clinic Owner of Defrauding Insurers

Dr. Poly Chen’s chain of pain clinics was billing $2,500 per COVID test.​

“Along with patients Chen was testing himself, employees and family members, sometimes dozens of times. The document says Chen “routinely performed two COVID-19 tests for each patient each time the patient entered the clinic.”

“The board concluded that Chen not only gave unnecessary tests, but was also involved in setting the outrageous prices. He’d contracted out billing to Oregon Billing and Collections, which is owned by Chen’s wife and operates out of the same office as Pain Care.”

Love it! So refreshing to see a pain doctor dabble in criminal activity that isn’t narcotics.

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[callmeanesthesia]

So he was billing them $2500. How much was he actually getting paid? They always leave that key detail out.

 

[hyperalgesia]

They should arrest the people who created a program that is so easy to defraud.

 

[powermd]

They should arrest the people who created a program that is so easy to defraud.

I get what you're saying buttttt...

I find it absolutely hilarious how quickly the resident conservatives break out the "blame the victim" card.

You've seen what happens when payors try to micromanage their way to a system that can't be gamed- basically all our procedures. Actual clinical care grinds to a halt.

Guys like this are the reason BCBS is checking notes to make sure you gave 1.5 mL of injectate to the SI, not 1.6 mL. ONE POINT FIVE.

 

[drusso]

https://omb.oregon.gov/Clients/ORMB/Public/VerificationDetails.aspx?EntityID=1483744

 

[SpineandWine]

I get what you're saying buttttt...

I find it absolutely hilarious how quickly the resident conservatives break out the "blame the victim" card.

You've seen what happens when payors try to micromanage their way to a system that can't be gamed- basically all our procedures. Actual clinical care grinds to a halt.

Guys like this are the reason BCBS is checking notes to make sure you gave 1.5 mL of injectate to the SI, not 1.6 mL. ONE POINT FIVE.

I give 2 ccs in SI joints, am I wrong?

 

[geauxg8rs]

I give 2 ccs in SI joints, am I wrong?

Only if you look good in silver bracelets

 

[Agast]

I give 2 ccs in SI joints, am I wrong?

If you ever get a peer to peer prior auth and they ask you how much you’re injecting, tell them 1.5 mL. Or straight to jail.

 

[CleanUp]

I give 2 ccs in SI joints, am I wrong?

Straight to hell for you buddy

 

[drusso]

I get what you're saying buttttt...

I find it absolutely hilarious how quickly the resident conservatives break out the "blame the victim" card.

You've seen what happens when payors try to micromanage their way to a system that can't be gamed- basically all our procedures. Actual clinical care grinds to a halt.

Guys like this are the reason BCBS is checking notes to make sure you gave 1.5 mL of injectate to the SI, not 1.6 mL. ONE POINT FIVE.

First, the status quo is not an accident.

Let that sink in. That's the first cognitive error physicians make when confronting bureaucratic nonsense. The status quo is not an "unintended consequence" or "misunderstanding" that can be corrected with "right thinking" and "more data." Instead, the status quo results from specific actions and inactions that caused its result.

Second, these kinds of nonsense limitations have NOTHING to do with SCIENCE. We do not have a SCIENTIFIC dispute with Medicare and other payers about the evidence for or against the volume of injectate in an SIJ injection or TPIs with or without steroids with or without image guidance. Stop making this into an imaginary SCIENTIFIC dispute!

This is about money and control. They don't want to spend money, and they want to control the physician-patient relationship—full stop.

They (the Government and Insurance Industry) don't CARE. Say it again: "They don't care."

Until MDs/DOs internalize these facts (It's not about SCIENCE; they want to control YOU, and they don't CARE), we will continue to fight the WRONG fight and continue to hand over our lunch at recess every day...

 

[Laryngospasm]

The problem is they are being mostly successful.. it’s ruining medicine. I can see massive changes just in the last 10 years. Hell we can’t even have bandages and other supplies in the room because everyone would die of infections.. it’s gotten to the point of entering the realm of Idiocracy. Sad thing is I don’t see it changing. When we built our new procedure room we were told all supplies had to be kept out of the room. Why not keep them out of the building? That would make even more sense.. I’m just about done.

 

[clubdeac]

I thought the join held 2.5cc of volume. Why did they use 1.5cc as their number. What a bunch of tools. guess I’ll be be changing my template

 

[PinchandBurn]

First, the status quo is not an accident.

Let that sink in. That's the first cognitive error physicians make when confronting bureaucratic nonsense. The status quo is not an "unintended consequence" or "misunderstanding" that can be corrected with "right thinking" and "more data." Instead, the status quo results from specific actions and inactions that caused its result.

Second, these kinds of nonsense limitations have NOTHING to do with SCIENCE. We do not have a SCIENTIFIC dispute with Medicare and other payers about the evidence for or against the volume of injectate in an SIJ injection or TPIs with or without steroids with or without image guidance. Stop making this into an imaginary SCIENTIFIC dispute!

This is about money and control. They don't want to spend money, and they want to control the physician-patient relationship—full stop.

They (the Government and Insurance Industry) don't CARE. Say it again: "They don't care."

Until MDs/DOs internalize these facts (It's not about SCIENCE; they want to control YOU, and they don't CARE), we will continue to fight the WRONG fight and continue to hand over our lunch at recess every day...

agreed

also this guy in question.

It's interesting how they are trying to smear him. It doesnt state what he actually collected. Also perhaps he was OON. What about what hospitals charged?

Also, the government creates the mandate for COVID tests. What do you think will happen?

 

[SpineandWine]

I thought the join held 2.5cc of volume. Why did they use 1.5cc as their number. What a bunch of tools. guess I’ll be be changing my template

LCD - Sacroiliac Joint Injections and Procedures (L39383)

Use this page to view details for the Local Coverage Determination for Sacroiliac Joint Injections and Procedures.

www.cms.gov

The LCD says volume of joint is variable from 0.5 to 2.5
Maybe they took the median

 

[PinchandBurn]

Why are Physicians penalized or criminalized if they are successful? Hospitals on the other hand.....

42 health systems ranked by net income

Check out 42 health systems ranked by net income for fiscal year 2023.

www.beckershospitalreview.com

 

[Agast]

Also, the government creates the mandate for COVID tests. What do you think will happen?

When did COVID testing become mandatory? People refused all the time.

 

[PinchandBurn]

When did COVID testing become mandatory? People refused all the time.

Not now.

It looks like this case goes back several years. Dont you recall people were being told that they couldnt go back to work unless they showed a 'negative' covid test. Others had to wait 10 days after a positive test result.

It was all over the map when there was no clear cut recommendation...

 

[bedrock]

When did COVID testing become mandatory? People refused all the time.

Wow. Only a hardcore liberal would be oblivious to all the people who were forced to take Covid tests or they would lose their jobs or lose 2 weeks of pay from their jobs.

 

[MitchLevi]

I give 2 ccs in SI joints, am I wrong?

SIJ holds on avg approx 1.5cc, with one previous study showing a range of 0.7 - 2.0cc.

I can’t fathom why it matters.

 

[powermd]

SIJ holds on avg approx 1.5cc, with one previous study showing a range of 0.7 - 2.0cc.

I can’t fathom why it matters.

Because getting fluid into the SI joint isn't remotely as reliable as an encapsulated hip, knee, or shoulder. Sometimes you get the perfect SI arthrogram- sometimes it just... won't... go... If you're load is blown at 1.5 mL, what't plan B? Draw up more steroid?

Personally, I draw up 3-4 mL allowing for some extravasation. I document the 1.5 mL part that I'm 100% sure went into the joint. 😉

 

[MitchLevi]

Because getting fluid into the SI joint isn't remotely as reliable as an encapsulated hip, knee, or shoulder. Sometimes you get the perfect SI arthrogram- sometimes it just... won't... go... If you're load is blown at 1.5 mL, what't plan B? Draw up more steroid?

Personally, I draw up 3-4 mL allowing for some extravasation. I document the 1.5 mL part that I'm 100% sure went into the joint. 😉

What?

Why does it matter from an insurance perspective?

 

[SpineandWine]

What?

Why does it matter from an insurance perspective?

Most likely SI fusion related/or ablation in a past life

 

[powermd]

What?

Why does it matter from an insurance perspective?

Now that's a good question. Why are they micromanaging a joint injection? This was kind of my point from earlier. Docs abuses the system with "too many" of something, the system bites back and tells us under what circumstances they'll pay. Now we don't get to decide the right amount, at least on paper. Reminds me of that Russian saying- they pretend to pay us, we pretend to work.

 

[Dr. Ice]

I despise insurance just as much as the next guy, but I’ve always said sij pathology is way way over diagnosed. It’s like the fall back for anyone with 5 minutes of unilateral buttock pain and an “ouch” with touching the area. Just cause fortin came up with his own “test” doesn’t mean we have to blindly follow it and inject steroids into a bizarre looking joint.

The absurdity also then lies in justifying the questionable pain generator by ablating it, fusing it and regening it at a ridiculously high rate.

 

[CleanUp]

I despise insurance just as much as the next guy, but I’ve always said sij pathology is way way over diagnosed. It’s like the fall back for anyone with 5 minutes of unilateral buttock pain and an “ouch” with touching the area. Just cause fortin came up with his own “test” doesn’t mean we have to blindly follow it and inject steroids into a bizarre looking joint.

The absurdity also then lies in justifying the questionable pain generator by ablating it, fusing it and regening it at a ridiculously high rate.

Thought provoking take.

Generally speaking what do you suggest is driving this pain then?

 

[Dr. Ice]

Thought provoking take.

Generally speaking what do you suggest is driving this pain then?

Referred pain from facet, glut strain from abnormal biomechanics likely from underlying hip/knee oa…anything but “sij”

 

[powermd]

Referred pain from facet, glut strain from abnormal biomechanics likely from underlying hip/knee oa…anything but “sij”

Fibro PSIS hypersensitivity, cluneal neuralgia, erector spinae/lat/QL tendinitis/myalgias, L5 radic.... all kinds of pain generators in that spot OTHER than the SI joint.

I'm personally pretty conservative about calling SI joint pain. I like to see a positive Gaenslen. In my hands, that's by far the most predictive test for a positive response to injection. I don't see a lot of positive Gaenslens despite + facets, myofascial TTP, etc.

If someone is tender over the PSIS... humor me. Go and palpate all the other bony prominences for fibro sensitivity. I see this A LOT. Then I put them on LDN.

 

[Dr. Ice]

Fibro PSIS hypersensitivity, cluneal neuralgia, erector spinae/lat/QL tendinitis/myalgias, L5 radic.... all kinds of pain generators in that spot OTHER than the SI joint.

I'm personally pretty conservative about calling SI joint pain. I like to see a positive Gaenslen. In my hands, that's by far the most predictive test for a positive response to injection. I don't see a lot of positive Gaenslens despite + facets, myofascial TTP, etc.

If someone is tender over the PSIS... humor me. Go and palpate all the other bony prominences for fibro sensitivity. I see this A LOT. Then I put them on LDN.

Agree, it should really be very much so a diagnosis of exclusion rather than an initial dogmatic algorithmic thought

 

[GoBeers]

Fibro PSIS hypersensitivity, cluneal neuralgia, erector spinae/lat/QL tendinitis/myalgias, L5 radic.... all kinds of pain generators in that spot OTHER than the SI joint.

I'm personally pretty conservative about calling SI joint pain. I like to see a positive Gaenslen. In my hands, that's by far the most predictive test for a positive response to injection. I don't see a lot of positive Gaenslens despite + facets, myofascial TTP, etc.

If someone is tender over the PSIS... humor me. Go and palpate all the other bony prominences for fibro sensitivity. I see this A LOT. Then I put them on LDN.

cluneal neuralgia vs. SI?

also, l5 radic but without radicular pain below knee?

 

[powermd]

cluneal neuralgia vs. SI?

also, l5 radic but without radicular pain below knee?

Can look up cluneal neuralgia- tough diagnosis to prove, but the patient should have immediate pain relief with injection in the fascia plane lateral and superior to the erector spinae, and medial to the PSIS. It's like a little recess next to the PSIS.

L5 radic not radiating to the leg is one of the tougher problems to diagnose because it looks like so many other things. My brother in law had this for a year with no diagnosis (no MRI). I thought he had piriformis. PTs thought he had SI joint dysfunction. Finally he got an MRI- big L4-5 extrusion affecting the traversing L5 root. I did a single ESI and he was 50% better in 3 days, 90% by 1 month, and hasn't needed another one in 7 years now.

My suspicion for this goes up if the pain acutely worsens with rotation and extension in a way and severity uncharacteristic of facet arthritis. Kind of like a variation on SLR- it tugs the nerve root

 

[MitchLevi]

L5 buttock pain I see frequently. Both L5 and S1 with exclusive buttock pain.

 

[lobelsteve]

L5 buttock pain I see frequently. Both L5 and S1 with exclusive buttock pain.

Referred pain from facet or disc, not radic..

 

[MitchLevi]

Referred pain from facet or disc, not radic..

So when I have a herniation at L5-S1 with L5 or S1 nerve root compression and the pt has exclusive buttock pain, I inject them with dex and they experience relief, that’s just the disk I’m treating?

Ppl with severe bony L5-S1 foraminal stenosis commonly have buttock pain that responds to TFESI. Is that disk pain too? These ppl often have facet disease that fails RFA.

 

[Ducttape]

Not now.

It looks like this case goes back several years. Dont you recall people were being told that they couldnt go back to work unless they showed a 'negative' covid test. Others had to wait 10 days after a positive test result.

It was all over the map when there was no clear cut recommendation.

there were pretty clear guidelines set by the CDC. and they were updated to reflect the risk of spread of disease and severity.

whether your institution or government chose to follow them is a separate issue.

So when I have a herniation at L5-S1 with L5 or S1 nerve root compression and the pt has exclusive buttock pain, I inject them with dex and they experience relief, that’s just the disk I’m treating?

technically it could be the steroid effect... between disc or nerve compression, though, you are more likely affecting the nerve.

Ppl with severe bony L5-S1 foraminal stenosis commonly have buttock pain that responds to TFESI. Is that disk pain too? These ppl often have facet disease that fails RFA.

is it the disease that fails RFA or the RFA that fails to appropriately target the pathology?

 

[MitchLevi]

is it the disease that fails RFA or the RFA that fails to appropriately target the pathology?

Who knows? We treat pain, not diabetes. Sensory and emotional condition that doesn’t necessarily behave the way we think it should.

 

[lobelsteve]

So when I have a herniation at L5-S1 with L5 or S1 nerve root compression and the pt has exclusive buttock pain, I inject them with dex and they experience relief, that’s just the disk I’m treating?

Ppl with severe bony L5-S1 foraminal stenosis commonly have buttock pain that responds to TFESI. Is that disk pain too? These ppl often have facet disease that fails RFA.

Yup.
Local effect of steroid with tincture of time and exercises to round things out.

 

[po_boy]

Referred pain from facet or disc, not radic..

Why not radic?

 

[lobelsteve]

Why not radic?

Dermatome to buttock and not further. Nope.

 

[nvrsumr]

Myotome

 

[powermd]

Dermatome to buttock and not further. Nope.

Degree of compression may matter to extent of radiation. More superficial fbers = more proximal pain. Deeper = more distal.

 

[sloh]

Degree of compression may matter to extent of radiation. More superficial fbers = more proximal pain. Deeper = more distal.

Evidence for this?

 

[bedrock]

Degree of compression may matter to extent of radiation. More superficial fbers = more proximal pain. Deeper = more distal.

I agree with you and disagree with steve.

A patient with buttock pain that improves with ESI simply has a more mild radiculopathy than someone with pain radiating to the knee or beyond.

 

[powermd]

Evidence for this?

Aside from the basic anatomy of spinal nerves, nope. Just observation that patients with compressed nerves can have varying degrees of radic, and all can respond to ESI.

Personally, I have piriformis syndrome. Most of the time it just causes a mild ache in the buttock. If it really flares up the pain will go into the lateral hip, then the shin. Never as far as the foot (yet). Piriformis stretch immediately alleviates it.

 

[RoloTomassi]

Stabbing pain in the butt is commonly radic. Distal symptoms usually improve first

 

[powermd]

Stabbing pain in the butt is commonly radic. Distal symptoms usually improve first

If it can be easily modulated by messing with the piriformis, and the MRI is clean, it's piriformis.

 

[drusso]

Dermatome to buttock and not further. Nope.

Are they tender to palpation in the region of the distribution of the cluneal nerves? Look to the cluneal for answers. The needle knows.

 

[Tboned]

Are they tender to palpation in the region of the distribution of the cluneal nerves? Look to the cluneal for answers. The needle knows.

Burn em baby!