thoughts on fraud and residency programs

[rehab_sports_dr]

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Most residency programs are housed in larger institutions. Sometimes, those larger institutions may be involved in fraud. I would be careful in linking the problems of a larger institution with that of the department.

Some examples:
UMDNJ- the larger institution of UMDNJ had some fraud that occured at the level of the highest people within the administration. Within NJ, this was a big deal, and was constantly in the NJ news and often in the national news.
While I was at UMDNJ, this had minimal impact on my experience as a resident. The GME was a little slower in returning reimbursement expenses from conferences (in part, probably, because they were scrutinizing things more thoroughly). We also had to take some online ethics courses to make sure we understood conflict of interest- a pain in the butt for an hour. Otherwise, it had no impact on us, and remained a great training experience.

RIC- the prior CFO made some accounting errors. This was picked up by the new CFO, and it appears to be a case of incompetence rather than fraud. RIC responded in an extremely positive way, put strong leaders in place, and I have seen no negative impact as a fellow. In fact, things are better from a training experience, because part of the aftermath was putting Joanne Smith, a clinician, in the CEO position. They have made some budgetery decisions that trimmed some ancillary clinical services, but for the most part RIC looks to be pulling through things stronger than ever.

UVA- I am not intimately familiar with how the fraud at HealthSouth has impacted the residency training program. As an outsider, I am guessing that it has very minimal impact. UVA was NOT the center of the HealthSouth fraud storm- it just happens to be one of many HealthSouth sites. For what my opinion is worth- I loved UVa when I interviewed there as a medical student, and my impression is that it has only improved as a residency training program since Casey Kerrigan became chair. if I were a medical student, I would look into it more, but my guess is that the fraud at HealthSouth is a peripheral issue which, like at UMDNJ and RIC, have minimal impact on the residency training.

 

[drusso]

Having said that, there are certainly situations where one's experience *WILL* be affected by institutional issues, departmental relationships, abuse, and fraud. Weak leadership translates into low morale. The problem is that an applicant has very little opportunity to learn about these issues before hand. That's why I think speaking to residents--not just those you meet on interview day--but others is important.

 

[rehab_sports_dr]

Good points DRusso.

I would advise:
1. Determine whether the fraud was committed within the department (which is obviously a huge red flag), or within the greater institution
2. If the department is clear, but the greater institution has problems, I think the key is to see how the department responds to the problem. **** happens outside of a department's control- great departments respond well, poor organizations respond poorly

 

[Disciple]

When I would do rehab consults/admits as a resident, if they weren't long enough, my instructors would try to scare me with this:

http://mac10.umc.pitt.edu/u/FMPro?-db=ustory&-lay=a&-format=d.html&storyid=5132&-Find

As far as I know, UPMC is still very respected academically.

Institutional fraud is one thing (though in this case the audit found no evidence of fraud). Fraud that may be intimately linked to the PM&R dept or to PM&R clinical training sites is what could cause problems for PM&R residents.

 

[jsaul]

when i was ay UPenn, they were fined some asrtonomical number by medicare for billing fraud.

 

[mdvol]

I very much agree with the above statements. When I was interviewing for residencies I knew about Healthsouth's situation and that of their CEO Mr. Scrushy's ( in fact I had lost a little on investing in their stock before the fall..ouch).

Luckily, I had done a month's subinternship at MCV/VCU in Richmond and when I saw how UVA with it's inpatient hospital half/owned by Healthsouth differed , it seemed very minor to me. I also loved other parts of the program more anyway.

In four years I can't say i have noted any detriment from the Healthsouth fraud issue translating to the residency program (Scrushy was miracuously found not guilty by the way). Do we have our own unique problems because we have the Healthsouth affiliation, sure. When those crop up, I consider learning opportunities , but the fraud issues have not played any role.

 

[medicineman1]

You all think that the field of PM&R is particularly susceptible to this scrutiny?

 

[rehab_sports_dr]

It's all conjecture, but I suspect that PM+R is probably less likely to be involved with fraud than many other specialties, simply because there is less money changing hands.