Podiatrists going to jail for cutting nails?

[air bud]

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As long as I'm griping, "shoe evaluation" is another load of 💩. My patients wear crocs/sandals/slip-ons to their appts with me specifically because they're easy to kick on and off for their doctor appt. These are obviously not their every day shoes but I'm supposed to infer a pattern of behavior from this? And what is the incidence of sandal-related ulcers anyway?

Sounds like some cutting edge research to be published in JAPMA

 

[heybrother]

Former OIG prosecutors talking about podiatry fraud. I haven't finished, but listening to them describing our coding feels surreal.

 

[Utvolsdpm]

Former OIG prosecutors talking about podiatry fraud. I haven't finished, but listening to them describing our coding feels surreal.

Brutal

Also 9/11 may have been an attempted podiatry fraud cover up?? Interesting

 

[Retrograde_Nail]

Former OIG prosecutors talking about podiatry fraud. I haven't finished, but listening to them describing our coding feels surreal.

The first fraud case they talk about...based out of New York and involves a professor from NYCPM. Typical.

 

[Feli]

14:45 mark, ftw... eeeverybody bagging on podiatry ROI. Wowza.

I do like how they ID the wound "graft" Qxxxx code fraud and overuse cycle perfectly ( 20:05 mark ). The practices still doing a lot of that are going to have real trouble in the coming years. Those are much bigger takebacks than RFC.

 

[Hybrocure]

14:45 mark, ftw... eeeverybody bagging on podiatry ROI. Wowza.

I do like how they ID the wound "graft" Qxxxx code fraud and overuse cycle perfectly ( 20:05 mark ). The practices still doing a lot of that are going to have real trouble in the coming years. Those are much bigger takebacks than RFC.

Hearing about podiatrists doing reimbursement for 8 bucks made me invert back into my chair in shame

 

[BubbaWub]

14:45 mark, ftw... eeeverybody bagging on podiatry ROI. Wowza.

I do like how they ID the wound "graft" Qxxxx code fraud and overuse cycle perfectly ( 20:05 mark ). The practices still doing a lot of that are going to have real trouble in the coming years. Those are much bigger takebacks than RFC.

I personally take offense to this. I make more than $8 per routine foot care patient. Usually to the tune of $30. That's almost 4x the amount they listed.

You can make a good living from providing quality, podiatric care.

These investigators are robots, only crunching numbers. The one thing they failed to mention was the amount of emotional reimbursement we receive from services rendered. I bet all those patients they interviewed loved their podiatrists. My patients love me.

Thank you

 

[DYK343]

Learned some practice management tips from that video. Dip the clippers in the bucket 1635 😍
Brilliant!!!

 

[air bud]

I personally take offense to this. I make more than $8 per routine foot care patient. Usually to the tune of $30. That's almost 4x the amount they listed.

You can make a good living from providing quality, podiatric care.

These investigators are robots, only crunching numbers. The one thing they failed to mention was the amount of emotional reimbursement we receive from services rendered. I bet all those patients they interviewed loved their podiatrists. My patients love me.

Thank you

Sir, as a podiatrist you are certainly are lacking in IQ. But I can tell you are off the charts in EQ. And for that you should be commended, regardless of the financial compensation you achieve.
Cheers.

 

[Feli]

Learned some practice management tips from that video. Dip the clippers in the bucket 1635 😍
Brilliant!!!

...

Indeed, and I adore the "practice management" tip right before that at 16:00 mark: to sit patients in a circle with DPM in center spin chair... to clip all super fast and bill so much you justify an avg 3-5min per pt... plus E&M! Genius stuff they don't teach ya in pod school (well, maybe NYCPM?).

THAT seeing 100+ pts/day would be the way to pay those student loans off in under 25 years???
You aint' gonna do that doing TARs and cavus foot recons.

 

[deelo89]

is all this auditing, clawbacks possible jail/fraud mostly in regards to striaght medicare or medicare advantage plans ?

 

[pod squad]

is all this auditing, clawbacks possible jail/fraud mostly in regards to striaght medicare or medicare advantage plans ?

Jail/fraud can only result from federal payers (Medicare/Medicaid). Private insurers (i.e. Medicare Advantage plans) have no legal standing to bring a criminal case. But they can certainly audit/clawback

 

[heybrother]

I'm not sure that's the case. See pasted text below. Awhile back I read about a scheme where out of network ASCs were billing patient's insurances sky high rates, and then forgiving the patient's their portion of the bill/deductible. When I read the story one of the things they pointed out was that when it became a fraud case it was no longer about you vs UHC getting their money back, but about the feds pursuing a fraud case with jail time on the line.

All that aside. I really do think your danger zone is - "Nursing Home" + Painful nails and / or lying about their systemic condition.

Has anyone ever been to a nursing home where the patients or the facility paid for a good portion of the services? I'm guessing the expectation is that insurance is billed for almost everyone and I'd even wager that if you routinely told the patient's they didn't qualify that the nursing home would find a new podiatrist who says yes.

 

[Bluecollarmed]

This is why you build/own nail clinics and cash pay. (seriously though anyone wanna get in on some of that action?) I see diabetics for annual routine care and assessment but no nails. Everything is sent to a hospital owned nail clinic and any that sneak into clinic from the schedulers I specifically tell I don't have nail cutters or dremel to do that (because I don't by design).

 

[Feli]

This is why you build/own nail clinics and cash pay. (seriously though anyone wanna get in on some of that action?) I see diabetics for annual routine care and assessment but no nails. Everything is sent to a hospital owned nail clinic and any that sneak into clinic from the schedulers I specifically tell I don't have nail cutters or dremel to do that (because I don't by design).

This will work fine and good... until your group/hospital admins change or the nail clinic RN or NP or non-op DPM or whoever quits. 😉

 

[GreenHousePub]

is all this auditing, clawbacks possible jail/fraud mostly in regards to striaght medicare or medicare advantage plans ?

The people going to jail have most likely been warned several times before action is taken and continue to engage in the same behavior.

It is never just a case of suddenly you need to go to court on Tuesday for a hearing.