I am sure that most everyone has gotten the emails about Dr. so and so reported that you should not do so and so, the latest one that I received was the one telling don't heat anything in plastic and don't freeze water in plastic bottles as they will release dioxins and cause cancer.
These Emails Are A Hoax!!!!!!
during elections you will get them about candidates, sometimes you will get them about gang initiations and don't blink your high beam while driving, there are thousands out there, they have been around for years and every few years the same ones pop up.
You can always go to Snopes.com and find out if it is true or not. But especially if you are taking medical advice of any kind, don't believe one source, one website, research it, find a reliable source and double check.
I would tell everyone to be wary, if you read something on a website , like this one, double check. Run a google search, see if the same information comes up from a reliable source.
If you have read many of my posts, you know that I have repeatedly said, don't believe everything that your own doctor says without doing your own research, let alone something a stranger on the internet says. The doctor has his wallet in mind and the stranger may just be spreading stuff to see how far it will spread.
Sunday, May 31, 2009
federal Trade Commission Compalaints On Lasik
I am becoming a true advocate of patients rights, after having been duped, lied to and personally harmed by a physicians failure to disclose information to me, among other things they did wrong, I feel like it is an absolute must to receive proper information.
Those who keep insisting on " fooling " their patients by not telling the truth about the risks of such procedures as lasik must be dealt with.
The FTC ( Federal Trade Commission ) deals with misleading and false advertisements , they have an online complaint form, or you may download it and send it in, to report such fraudsters such as lasik physicians. You may do so with or without revealing information about yourself.
What is false advertisement?
According to the FDA ( Food and Drug Administration ) physicians, vision centers , lasik centers and others , must include the RISKS of lasik surgery when they advertise.
For example, I visited the Downing and McPeak vision center website, low and behold, I found testimonials about how great lasik was, but no disclosure on the risks , this would seem to be in violation of the FDA ruling, you look for yourself and then let me know if you find the same.
Too often patients are given the " oh how great it is " spiel without being informed of the risks to themselves, more and more patients are reporting loss of vision, blindness and lifetime problems because of this procedure, but they are not given the information on the risks so that they may make an informed decision, everyone must work on insuring patient safety.
Be diligent, report these fraudsters to the proper authorities!!
Those who keep insisting on " fooling " their patients by not telling the truth about the risks of such procedures as lasik must be dealt with.
The FTC ( Federal Trade Commission ) deals with misleading and false advertisements , they have an online complaint form, or you may download it and send it in, to report such fraudsters such as lasik physicians. You may do so with or without revealing information about yourself.
What is false advertisement?
According to the FDA ( Food and Drug Administration ) physicians, vision centers , lasik centers and others , must include the RISKS of lasik surgery when they advertise.
For example, I visited the Downing and McPeak vision center website, low and behold, I found testimonials about how great lasik was, but no disclosure on the risks , this would seem to be in violation of the FDA ruling, you look for yourself and then let me know if you find the same.
Too often patients are given the " oh how great it is " spiel without being informed of the risks to themselves, more and more patients are reporting loss of vision, blindness and lifetime problems because of this procedure, but they are not given the information on the risks so that they may make an informed decision, everyone must work on insuring patient safety.
Be diligent, report these fraudsters to the proper authorities!!
Thursday, May 28, 2009
Lasik Surgery Be Informed!
Information, information and more information.
All too often we don't take the time to be informed, Big Mistake number 1.
Any surgery is not routine when it comes to you, to your well being, to your quality of life. I found out the hard way, if you have read my other posts then you know that for me, surgery was not routine, unfortunately, for my doctor, he treated it as if it was routine and I believed him when he said he was experienced in retinitis pigmentosa, who would have thunk that a doctor would lie!!!! I was naive!
In another post I told about the vision center that I went to and how now they are claiming to have been " awarded " as one of the top centers in the US or some such nonsense. Of course these so called " awards " are for many centers and doctors just a paid membership advertising deal, connections with money will get many " businesses " to give out " many " awards! Tell you what, if you believe that these are honest awards, I will rent you a keyboard and then give you " Gold Seal Author of the Year Award " all for a price of 1 million a year. ( Didn't you always want to be a top author? ) that is pretty much what many of these " awards " are.
I ran across a site that has much information and links about lasik disasters, about the scams that lasik doctors pull, and about what to look out for, what you should know.
http://www.lasiksos.com/
You may still want to have lasik performed, but you can inform yourself as to the best doctors, what to look for and what to avoid. Good Luck.
All too often we don't take the time to be informed, Big Mistake number 1.
Any surgery is not routine when it comes to you, to your well being, to your quality of life. I found out the hard way, if you have read my other posts then you know that for me, surgery was not routine, unfortunately, for my doctor, he treated it as if it was routine and I believed him when he said he was experienced in retinitis pigmentosa, who would have thunk that a doctor would lie!!!! I was naive!
In another post I told about the vision center that I went to and how now they are claiming to have been " awarded " as one of the top centers in the US or some such nonsense. Of course these so called " awards " are for many centers and doctors just a paid membership advertising deal, connections with money will get many " businesses " to give out " many " awards! Tell you what, if you believe that these are honest awards, I will rent you a keyboard and then give you " Gold Seal Author of the Year Award " all for a price of 1 million a year. ( Didn't you always want to be a top author? ) that is pretty much what many of these " awards " are.
I ran across a site that has much information and links about lasik disasters, about the scams that lasik doctors pull, and about what to look out for, what you should know.
http://www.lasiksos.com/
You may still want to have lasik performed, but you can inform yourself as to the best doctors, what to look for and what to avoid. Good Luck.
Wednesday, May 27, 2009
$68 Billion Dollars in healthcare fraud
That is how much the US loses each year to health care fraud, 68 Billion Dollars! That is the amount not available to use for needed health care, for people that really need it, or to make health care better, or to lower costs, allthis money that is going down the drain costs everyone, it raises the cost of your premiums, it lowers the amount of services you get, it lowers the amount of quality health care available, it wastes taxpayers dollars.
More people need to turn in these companies that are over charging the health care system, are unbundling services in order to bill insurance or medicare a higher amount, or billing for services or procedures not rendered.
The US spends about 2 TRILLION Dollars a year in health care costs, so I can understand why we cannot afford to have better, bigger, all included , coverage, but we could get a lot closer if we had that 68 Billion dollars a year to use for the good of the people instead of for greedy doctors 2nd, third and fourth vacation homes!!!!
These links are a few that are trying to help the cause!!
http://www.nofreelunch.org/
http://www.wnd.com/index.php?pageId=64813
have you ever wondered whether your eyecare doctors have an incentive to
scam you??
http://www.jpands.org/vol11no4/gervais.pdf
More people need to turn in these companies that are over charging the health care system, are unbundling services in order to bill insurance or medicare a higher amount, or billing for services or procedures not rendered.
The US spends about 2 TRILLION Dollars a year in health care costs, so I can understand why we cannot afford to have better, bigger, all included , coverage, but we could get a lot closer if we had that 68 Billion dollars a year to use for the good of the people instead of for greedy doctors 2nd, third and fourth vacation homes!!!!
These links are a few that are trying to help the cause!!
http://www.nofreelunch.org/
http://www.wnd.com/index.php?pageId=64813
have you ever wondered whether your eyecare doctors have an incentive to
scam you??
http://www.jpands.org/vol11no4/gervais.pdf
Tuesday, May 26, 2009
Are your eye doctors getting too big?
I have noticed a trend, all health care and yes, even those who take care of our eyes, have gone big business.
The little old towns vision center I went to, I found they make way over 10 million a year, when your little old friendly doc has that kind of money generated, you had better look out for yourself!
Does that mean less personal care? Could it mean that we are getting run through a assembly line type service instead of one on one that we need for quality care? I believe that I was given care that was of a " one size fits all " type , that doesn't even work for cheap t shirts let alone medical care!
I went to the home town , eye care specialists, the " good neighbor " type place, but what I found wasn't personal care, , when they spend more time looking over your insurance with a gleam in their eye, than they do looking over your eyes, something is not going to go right. I spent way more time with the billing/insurance clerk than I did with good ole doc.
When I last visited Downing and McPeak eye care, vision center, I noticed that there was a waiting room full, while waiting I also noticed that the age of those waiting were definitely the medicare crowd ( big business needs big medicare money ) If you look at the DOJ then you know that big medicare can mean big fraud.
After being ushered from one waiting room to another,drops put in, techs taking tests ( by the way, if you can, watch and see if the tech cleans the lens after a patient leaves, this can be very harmful and I noticed that they don't always do this )
I see Dr Porter for 2 minutes tops, he flips the lens on his machine once and asked which was better, then decided I HAD to have surgery, ( at that point I should have known to get second opinion,, ah,, the trust issue )
Since then, I have researched how much surgery they do? hmm,, in 2003 their surgical center performed 1895 operations ( of course they own this building , gotta get them surgeries to pay for it?) But in 2007 they performed 3238 surgeries, now you have to ask, are there almost twice as many people needing operations, or does this big business need almost twice the profit?
Your "hometown " friendly optometrist could be a Donald Trump in disguise,, would we really be that comfortable trusting these guys if we realized that they are more business tycoon than doctor?
The little old towns vision center I went to, I found they make way over 10 million a year, when your little old friendly doc has that kind of money generated, you had better look out for yourself!
Does that mean less personal care? Could it mean that we are getting run through a assembly line type service instead of one on one that we need for quality care? I believe that I was given care that was of a " one size fits all " type , that doesn't even work for cheap t shirts let alone medical care!
I went to the home town , eye care specialists, the " good neighbor " type place, but what I found wasn't personal care, , when they spend more time looking over your insurance with a gleam in their eye, than they do looking over your eyes, something is not going to go right. I spent way more time with the billing/insurance clerk than I did with good ole doc.
When I last visited Downing and McPeak eye care, vision center, I noticed that there was a waiting room full, while waiting I also noticed that the age of those waiting were definitely the medicare crowd ( big business needs big medicare money ) If you look at the DOJ then you know that big medicare can mean big fraud.
After being ushered from one waiting room to another,drops put in, techs taking tests ( by the way, if you can, watch and see if the tech cleans the lens after a patient leaves, this can be very harmful and I noticed that they don't always do this )
I see Dr Porter for 2 minutes tops, he flips the lens on his machine once and asked which was better, then decided I HAD to have surgery, ( at that point I should have known to get second opinion,, ah,, the trust issue )
Since then, I have researched how much surgery they do? hmm,, in 2003 their surgical center performed 1895 operations ( of course they own this building , gotta get them surgeries to pay for it?) But in 2007 they performed 3238 surgeries, now you have to ask, are there almost twice as many people needing operations, or does this big business need almost twice the profit?
Your "hometown " friendly optometrist could be a Donald Trump in disguise,, would we really be that comfortable trusting these guys if we realized that they are more business tycoon than doctor?
Thursday, May 21, 2009
Google Your Eyesight
Use your search engine for what matters most to you, your sight
You can check with web sites that rate doctors to check out your vision care specialists, of course this isn't going to be totally truthful, supposedly ratings are given by customers , but I have found some that look like maybe the employees or even doctors have gotten on there and given " their " opinion, and who can tell? It is a start just a small step.
Check out a possible eye care center by looking at their website, is it informative? Is it open to questions, can you email them and ask for more information? Is it informing? Is it honest and truthful?
For example, I looked at Downing and McPeak on the web, they give " testimonials " from supposed customers about how great they see now , after lasik, does that give you the full picture? If a center doesn't at least state by the testimonials that there are some risks involved , then does that start showing you that maybe they are a money machine instead of a vision " care " facility?
Also on the Downing and McPeak site , notice that they tell you they were " awarded " as being a top lasik center by TLC vision corporation? Sounds good right? Until you look at who TLC is, they rent and sell equipment , provide staff etc to companies ,,,, like,,, Downing and McPeak, so this company, that Downing and McPeak say gives them kudos, have financial strings to their center, not exactly a trustworthy account , you can bet that TLC has given these so called " awards " to many many of their customers!!!
Even when you go to the glossary page , there are mistakes or half truths about what some of the conditions are. The term retinitis pigmentosa has a different definition if you look into it, they might be partially correct but not a very good professional explanation.
Can you email them? no
Under their doctors profile , have many of them published research papers in the professional journals?
Look for more substance in a Doctor for your eyes than just a slick little ad type page.
Slick Ads are usually for the production type companies that want to run you through surgery quickly and make the money quickly, they usually don't really take " care " of their patients.
You can check with web sites that rate doctors to check out your vision care specialists, of course this isn't going to be totally truthful, supposedly ratings are given by customers , but I have found some that look like maybe the employees or even doctors have gotten on there and given " their " opinion, and who can tell? It is a start just a small step.
Check out a possible eye care center by looking at their website, is it informative? Is it open to questions, can you email them and ask for more information? Is it informing? Is it honest and truthful?
For example, I looked at Downing and McPeak on the web, they give " testimonials " from supposed customers about how great they see now , after lasik, does that give you the full picture? If a center doesn't at least state by the testimonials that there are some risks involved , then does that start showing you that maybe they are a money machine instead of a vision " care " facility?
Also on the Downing and McPeak site , notice that they tell you they were " awarded " as being a top lasik center by TLC vision corporation? Sounds good right? Until you look at who TLC is, they rent and sell equipment , provide staff etc to companies ,,,, like,,, Downing and McPeak, so this company, that Downing and McPeak say gives them kudos, have financial strings to their center, not exactly a trustworthy account , you can bet that TLC has given these so called " awards " to many many of their customers!!!
Even when you go to the glossary page , there are mistakes or half truths about what some of the conditions are. The term retinitis pigmentosa has a different definition if you look into it, they might be partially correct but not a very good professional explanation.
Can you email them? no
Under their doctors profile , have many of them published research papers in the professional journals?
Look for more substance in a Doctor for your eyes than just a slick little ad type page.
Slick Ads are usually for the production type companies that want to run you through surgery quickly and make the money quickly, they usually don't really take " care " of their patients.
Post cancer CT scans
For anyone who is going through this, you know what I mean, my husband had a GIST tumor removed 2 years ago, totally removed, gone, etc, first year he went every 6 months for a scan, now we are doing it every year.
Today was the day, for the last several weeks at least, you start getting anxious, every twitch and pain makes you wonder, yet you really don't talk about it, you don't want to admit that you are scared still.
Today we got up before daylight to drive the 2 hours ( different time zone ) to wait in one waiting area, then get moved to another waiting area, finally drink the contrast, wait some more, then get the scan.
Now you have to waste an hour before the appointment with the doctor.
In the doctors waiting room, a woman walks up and wants to know if you will sign papers to be included in a study since GIST tumor patients are a little rare, now you really ramp up the anxiety level, wonder if she knows something we don't? Does she want to get the signature before we get the bad news?
Finally DR walks into the room, makes small talk , asks how you are doing, you really want to grab him by the neck and scream YES OR NO????
Finally he goes and reads the scan, comes back and says, everything is perfect!!!!!!!!!!!!! YEAHHHHHHHHHHH BREATH!!!!!!!!!!!
We know that in 8 or 9 months we will start building up the anxiety level once again,, but for today, we are happy, we are thankful, we are blessed.
My husbands tumor was larger than normal, sort of small watermelon size, which is one of the aspects they use to determine your risk of it coming back, large is bad,, on the other hand, the other measurement of risk is how " cancerous " it was, in other words, how many cells had divided, his was low, which is good, so will never really be sure he is low risk because of size.
Reducing the stress leading up to your time for another scan?
Keep busy, find something funny, jokes, stories , anything. Go out to eat, go to a movie, don't sit around and think about it!!!
Day of the scan, take a book, magazine , something to do in the waiting areas, something light, funny and entertaining!!!
Above all, have faith. Good Luck.
Today was the day, for the last several weeks at least, you start getting anxious, every twitch and pain makes you wonder, yet you really don't talk about it, you don't want to admit that you are scared still.
Today we got up before daylight to drive the 2 hours ( different time zone ) to wait in one waiting area, then get moved to another waiting area, finally drink the contrast, wait some more, then get the scan.
Now you have to waste an hour before the appointment with the doctor.
In the doctors waiting room, a woman walks up and wants to know if you will sign papers to be included in a study since GIST tumor patients are a little rare, now you really ramp up the anxiety level, wonder if she knows something we don't? Does she want to get the signature before we get the bad news?
Finally DR walks into the room, makes small talk , asks how you are doing, you really want to grab him by the neck and scream YES OR NO????
Finally he goes and reads the scan, comes back and says, everything is perfect!!!!!!!!!!!!! YEAHHHHHHHHHHH BREATH!!!!!!!!!!!
We know that in 8 or 9 months we will start building up the anxiety level once again,, but for today, we are happy, we are thankful, we are blessed.
My husbands tumor was larger than normal, sort of small watermelon size, which is one of the aspects they use to determine your risk of it coming back, large is bad,, on the other hand, the other measurement of risk is how " cancerous " it was, in other words, how many cells had divided, his was low, which is good, so will never really be sure he is low risk because of size.
Reducing the stress leading up to your time for another scan?
Keep busy, find something funny, jokes, stories , anything. Go out to eat, go to a movie, don't sit around and think about it!!!
Day of the scan, take a book, magazine , something to do in the waiting areas, something light, funny and entertaining!!!
Above all, have faith. Good Luck.
Monday, May 18, 2009
Dr Porter, after cataract sirgery
After the cataract surgery I had " post op " visits with Dr Porter, I kept telling him that I couldn't see very well, what was going on, he kept assuring me that maybe I had a little swelling etc, not to worry, On the last visit to his office, he finally did admit that I would never get my near vision back ( I hadn't been told that cataract surgery robs you of any vision, only that it was supposed to improve your vision ) , he never did really admit that my distant vision was far worse than it had been, but had the gall to just start talking about wanting to do another procedure on the first eye and set up a date to do the second eye!!!! I asked him was the swelling down, was there any medical reason to have to come back? He said yes, I was fine, and no, no real reason to have to come back other than scheduling the next eye. I told him since he said I was " fine " I would not be coming back, I could not see, and that I sure wasn't letting him touch my other eye. ( unfornuately, he had messed up the eye with the best vision )
I went home and cried, it has been 18 months since I have been to the Downing and McPeak office, and I still can't talk about this or even write it without tearing up, you do not realize how much you value your sight until some doctor takes it, I told you in an earlier post that I loved to read, cook and shop? Not so much anymore, I need a magnifyer to do the simplest things, I can't see the price tags on anything when I am shopping without magnifying it, I can't see a recipe to cook, and what I had loved to do since I was young was to read , mostly fiction, now it takes forever to read a simple book with magnifying glasses and can't read for very long at that because I get headaches and my eyes tire.
I went home and cried, it has been 18 months since I have been to the Downing and McPeak office, and I still can't talk about this or even write it without tearing up, you do not realize how much you value your sight until some doctor takes it, I told you in an earlier post that I loved to read, cook and shop? Not so much anymore, I need a magnifyer to do the simplest things, I can't see the price tags on anything when I am shopping without magnifying it, I can't see a recipe to cook, and what I had loved to do since I was young was to read , mostly fiction, now it takes forever to read a simple book with magnifying glasses and can't read for very long at that because I get headaches and my eyes tire.
How I lost my eye sight
You just decide one day that you are over due to have your eye pressure checked . Simple right? You call the most well known eye care place in town, for me it was Downing and McPeak vision center.
I even asked about which doc would be best since I have a previous eye condition, even though all I wanted was a pressure check up.
Well, it all went down hill from there, the receptionist said she would make me an appointment with a Dr Porter since he also had a medical license.
I kept telling Dr Porter and then his assistant that my near vision is very dear to me as with the RP, I can't drive, so the up close things are the important things to me, I like to read, I like to cook and I to shop.
Of course they waited until after I had my eyes dilated to bring out the forms, forms that I could not now see, take it from me, NEVER sign forms that you cannot see, somehow insurance forms mysteriously turned into forms saying I had seen a video ( I had never seen anyone in the place watching a video during any of my visits )
After being told that I had to have surgery, I asked the " right " questions, did he have experience, patients, with RP, was there any problems with surgery because I had RP, told yes, experience, yes had rp patients, no never a problem,,, course now I found out I was high risk for surgery, should have had extra days pre-op, should have made sure cataract was causing problems and not the rp, should have been told the risks, and on and on,,, but I didn't know then.
Believe me, records can be changed, notes " added" and no records of course ,when they tell you about having experience with a certain problem.
You want the straight truth when you go to see your eye doctor? Take a recorder, betcha they tell it different if they know it is being recorded!!!
Sadly , that is your best protection .
I even asked about which doc would be best since I have a previous eye condition, even though all I wanted was a pressure check up.
Well, it all went down hill from there, the receptionist said she would make me an appointment with a Dr Porter since he also had a medical license.
I kept telling Dr Porter and then his assistant that my near vision is very dear to me as with the RP, I can't drive, so the up close things are the important things to me, I like to read, I like to cook and I to shop.
Of course they waited until after I had my eyes dilated to bring out the forms, forms that I could not now see, take it from me, NEVER sign forms that you cannot see, somehow insurance forms mysteriously turned into forms saying I had seen a video ( I had never seen anyone in the place watching a video during any of my visits )
After being told that I had to have surgery, I asked the " right " questions, did he have experience, patients, with RP, was there any problems with surgery because I had RP, told yes, experience, yes had rp patients, no never a problem,,, course now I found out I was high risk for surgery, should have had extra days pre-op, should have made sure cataract was causing problems and not the rp, should have been told the risks, and on and on,,, but I didn't know then.
Believe me, records can be changed, notes " added" and no records of course ,when they tell you about having experience with a certain problem.
You want the straight truth when you go to see your eye doctor? Take a recorder, betcha they tell it different if they know it is being recorded!!!
Sadly , that is your best protection .
Sunday, May 17, 2009
You and Fraud
What can you do about medical fraud? Actually, many things, it is up to people , ordinary people to stop fraud, by doing so you help people to not become victims, you help to stop the high cost of insurance, stop taxpayers dollars from being wasted, and improve the health care system!!!!
Share in the recovery
On top of this, if you are the first one to report fraud , you can be entitled to a percentage of the money that is recovered!! Often times this is 25 percent of the recovered amount! some examples,
will receive $1.75 million as his share ( florida April 14, 2008 )
will receive $1,020,000 as his statutory share of the proceeds ( california march, 2009 )
. Dr. Tiesinga will receive $300,000 as his share of the proceeds of the settlement ( washington 2007)
, will receive $412,500 as her share of the settlement ( Illinois 2008 )
Not to even mention that you will be doing a world of good.
There were many companies out there that had someone in the inside, or someone who used the company and knew of illicit goings on, had reported them, then they could have stopped the company from going bankrupt, stopped them from losing employee retirements etc.
Is it your ethical duty?
In a nutshell, yes. People are harmed by fraudulant acts, if it is overbilling they are harmed by higher costs of insurance, or taxes if medicare is over billed, if it is by opthamologists performing unwarranted surgeries, you can save patients harm, there are many ways it helps to put a stop to fraud or abuse!
How can you help?
Here are a few law firms that take cases, I do not have any connection to any of these.
Toll Free 1 (888) 482-6825
Tel: 202.833.4567212) 376-5666 1-888-933-1514
1-888-775-3779
Attorney General Conway Announces Optometrist Indictment ( kentucky )
Citizens are urged to report suspected fraud or elder abuse by calling the Attorney General’s tip line at 1-877-ABUSE TIP (1-877-228-7384).
What kinds of fraud to look for ? some examples are.
Services not rendered
Upcoding schemes and Unbundling
Kickbacks and Self Referrals
Falsely Certifying and Giving False Information
Lack of Medical Necessity
Fraudulent Cost Reports
Grant or Research Fraud
SERVICES NOT RENDERED:
The simplest scheme of healthcare fraud is the billing for services that were never rendered to patients.
Examples under this scheme include healthcare providers billing Medicare or Medicaid for services that were never performed, medical supplies and equipment that were never delivered, and lab or medical tests that never occurred.
UPCODING AND UNBUNDLING:
Upcoding
Another common scheme involves upcoding to obtain a higher reimbursement than one is entitled to. Medicare and Medicaid systems use a set of billing codes which healthcare providers use in billing for services. These codes are known as the HCPCS codes. In an upcoding scheme, providers wrongfully use a higher paying code to fraudulently reflect that a more expensive procedure or device was involved in the patient’s treatment. These codes are billed electronically and typically slip through the system unless caught through a random audit of only approximately 2% of the claims each year. The only other way to catch the fraudulent use of these higher codes is for an insider to come forward and report the upcoding.
Unbundling
Another common example of coding fraud is called "unbundling." When procedures or lab tests involve a number of related services or tests that are typically performed together, Medicare and Medicaid have specific billing codes that must be used to obtain reimbursement for all of the associated services or tests as a whole, rather than allowing reimbursement for each of the related services or tests billed separately.
KICKBACKS:
A federal statute known as The Stark Law, is designed to prevent billing for Medicare services resulting from abusive self-referrals and kickbacks. Under the Stark Law, a physician is prohibited from making any referral to a provider of designated health services if the physician has a "financial relationship" with the provider, unless an exception applies.
Examples
an HMO provider had come under increasing pressure to switch from an equally effective but significantly less expensive alternative drug because the pharmaceutical company offered its doctors a panoply of inducements to prescribe the expensive drug, including ski and golfing trips, free televisions and VCRs, cocktail party bar tabs, and an array of free products and services.
FALSE CERTIFICATIONS AND INFORMATION:
Health care providers are required to act openly and honestly with the Medicare and Medicaid programs and submit claims based upon accurate information. In addition, Medicare providers are required to disclose all known errors and omissions in their claims for Medicare reimbursement. Providers who submit false claims in violation of these requirements violate the False Claims Act.
Examples
In Mississippi, a hospital chain agreed to a $1.5 million settlement of a qui tam lawsuit in which it was alleged that the hospital billed under physician provider numbers when, in fact, the services were rendered by nurses rather than physicians.
LACK OF MEDICAL NECESSITY:
It is improper to bill Medicare for services or treatment that is not medically necessary. To knowingly do so is a violation of the False Claims Act.
Examples
In New York, an ophthalmologist agreed to pay a settlement of $8.5 million for performing medically unnecessary, contraindicated, and unperformed ophthalmologic services. The settlement agreement provided that the doctor would be permanently excluded from all federally funded health care programs. The physician’s own medical charts did not justify the wide scope of services for which he submitted bills. He also created and submitted new documentation, sometimes years after the questioned dates of service, to attempt to justify his claims after Medicare requested supporting documentation.
In Illinois, a physician group filed false claims for reimbursement to Medicare and Medicaid by submitting claims for inpatient services that were not supported by sufficient documentary evidence and filed claims for both inpatient and outpatient services that were wrongly coded. The physician group agreed to pay an $8.275 million settlement.
An optometrist billing for the comprehensive eye exam when he or she performed the lower level exam
An ophthalmologist falsifying documentation for a test that is used to establish the need for cataract surgery
Audits by the Office of the Inspector General reveal that $1 out of every $7 spent on
Medicare and Medicaid is lost due to fraud and abuse. This problem affects everyone.
It affects those who depend on these programs by diminishing the quality of treatment
they receive. It affects families and caregivers by decreasing the funding available for
important health care support. It affects all taxpayers by wasting billions of dollars per
year.
Share in the recovery
On top of this, if you are the first one to report fraud , you can be entitled to a percentage of the money that is recovered!! Often times this is 25 percent of the recovered amount! some examples,
will receive $1.75 million as his share ( florida April 14, 2008 )
will receive $1,020,000 as his statutory share of the proceeds ( california march, 2009 )
. Dr. Tiesinga will receive $300,000 as his share of the proceeds of the settlement ( washington 2007)
, will receive $412,500 as her share of the settlement ( Illinois 2008 )
Not to even mention that you will be doing a world of good.
There were many companies out there that had someone in the inside, or someone who used the company and knew of illicit goings on, had reported them, then they could have stopped the company from going bankrupt, stopped them from losing employee retirements etc.
Is it your ethical duty?
In a nutshell, yes. People are harmed by fraudulant acts, if it is overbilling they are harmed by higher costs of insurance, or taxes if medicare is over billed, if it is by opthamologists performing unwarranted surgeries, you can save patients harm, there are many ways it helps to put a stop to fraud or abuse!
How can you help?
Here are a few law firms that take cases, I do not have any connection to any of these.
Toll Free 1 (888) 482-6825
Tel: 202.833.4567212) 376-5666 1-888-933-1514
1-888-775-3779
Attorney General Conway Announces Optometrist Indictment ( kentucky )
Citizens are urged to report suspected fraud or elder abuse by calling the Attorney General’s tip line at 1-877-ABUSE TIP (1-877-228-7384).
What kinds of fraud to look for ? some examples are.
Services not rendered
Upcoding schemes and Unbundling
Kickbacks and Self Referrals
Falsely Certifying and Giving False Information
Lack of Medical Necessity
Fraudulent Cost Reports
Grant or Research Fraud
SERVICES NOT RENDERED:
The simplest scheme of healthcare fraud is the billing for services that were never rendered to patients.
Examples under this scheme include healthcare providers billing Medicare or Medicaid for services that were never performed, medical supplies and equipment that were never delivered, and lab or medical tests that never occurred.
UPCODING AND UNBUNDLING:
Upcoding
Another common scheme involves upcoding to obtain a higher reimbursement than one is entitled to. Medicare and Medicaid systems use a set of billing codes which healthcare providers use in billing for services. These codes are known as the HCPCS codes. In an upcoding scheme, providers wrongfully use a higher paying code to fraudulently reflect that a more expensive procedure or device was involved in the patient’s treatment. These codes are billed electronically and typically slip through the system unless caught through a random audit of only approximately 2% of the claims each year. The only other way to catch the fraudulent use of these higher codes is for an insider to come forward and report the upcoding.
Unbundling
Another common example of coding fraud is called "unbundling." When procedures or lab tests involve a number of related services or tests that are typically performed together, Medicare and Medicaid have specific billing codes that must be used to obtain reimbursement for all of the associated services or tests as a whole, rather than allowing reimbursement for each of the related services or tests billed separately.
KICKBACKS:
A federal statute known as The Stark Law, is designed to prevent billing for Medicare services resulting from abusive self-referrals and kickbacks. Under the Stark Law, a physician is prohibited from making any referral to a provider of designated health services if the physician has a "financial relationship" with the provider, unless an exception applies.
Examples
an HMO provider had come under increasing pressure to switch from an equally effective but significantly less expensive alternative drug because the pharmaceutical company offered its doctors a panoply of inducements to prescribe the expensive drug, including ski and golfing trips, free televisions and VCRs, cocktail party bar tabs, and an array of free products and services.
FALSE CERTIFICATIONS AND INFORMATION:
Health care providers are required to act openly and honestly with the Medicare and Medicaid programs and submit claims based upon accurate information. In addition, Medicare providers are required to disclose all known errors and omissions in their claims for Medicare reimbursement. Providers who submit false claims in violation of these requirements violate the False Claims Act.
Examples
In Mississippi, a hospital chain agreed to a $1.5 million settlement of a qui tam lawsuit in which it was alleged that the hospital billed under physician provider numbers when, in fact, the services were rendered by nurses rather than physicians.
LACK OF MEDICAL NECESSITY:
It is improper to bill Medicare for services or treatment that is not medically necessary. To knowingly do so is a violation of the False Claims Act.
Examples
In New York, an ophthalmologist agreed to pay a settlement of $8.5 million for performing medically unnecessary, contraindicated, and unperformed ophthalmologic services. The settlement agreement provided that the doctor would be permanently excluded from all federally funded health care programs. The physician’s own medical charts did not justify the wide scope of services for which he submitted bills. He also created and submitted new documentation, sometimes years after the questioned dates of service, to attempt to justify his claims after Medicare requested supporting documentation.
In Illinois, a physician group filed false claims for reimbursement to Medicare and Medicaid by submitting claims for inpatient services that were not supported by sufficient documentary evidence and filed claims for both inpatient and outpatient services that were wrongly coded. The physician group agreed to pay an $8.275 million settlement.
An optometrist billing for the comprehensive eye exam when he or she performed the lower level exam
An ophthalmologist falsifying documentation for a test that is used to establish the need for cataract surgery
Audits by the Office of the Inspector General reveal that $1 out of every $7 spent on
Medicare and Medicaid is lost due to fraud and abuse. This problem affects everyone.
It affects those who depend on these programs by diminishing the quality of treatment
they receive. It affects families and caregivers by decreasing the funding available for
important health care support. It affects all taxpayers by wasting billions of dollars per
year.
Saturday, May 16, 2009
laugh or cry, a little humor
An Intern got called late one Friday night by a VA ward nurse to clarify an order for some drug to be delivered "AS, bid". Having never heard of the drug and no idea what the heck"AS" means, Rick asked why the patient was in the hospital. "Well, he's having a colonoscopy on Monday", the nurse replied. Rick astutely deduced that 'AS' must mean 'anal sphincter', and ordered the drug to be delivered as such.
The ENT resident came by on Monday morning to find that the patient had been getting cortisporin otic up his backside twice a day for an entire weekend. AS means "left ear".
A worried patient tells an opthalmologist Doc, I am very scared about the outcome of the operation on my left eye. What are my chances?" Grinning doctorsays " Don't worry, you'll never see the difference "
The ENT resident came by on Monday morning to find that the patient had been getting cortisporin otic up his backside twice a day for an entire weekend. AS means "left ear".
A worried patient tells an opthalmologist Doc, I am very scared about the outcome of the operation on my left eye. What are my chances?" Grinning doctorsays " Don't worry, you'll never see the difference "
Is Fraud Really all that Common in the Medical Field?
Between 44,000 and 98,000 people die in hospitals annually each year due to preventable medical errors, the Institute of Medicine found.
How horrible, now can you imagine how many lives have been ruined, or compromised because of mistakes that you never know about, or that were never reported, or that was covered up by the medical field?
Which brings up one subject, get copies of your records, you won't believe what is in some of them that shouldn't be. Look at the bills, see if the billing is correct, see if the diagnosis is correct, see what you sign, before you sign it.
Between 1988 and May 1992, this opthalmologist received $15.5 million from Medicare, primarily for cataract and eyelid surgeries that were not medically necessary or for which false billings were submitted.
http://www.usdoj.gov/opa/health/hcf1.htm
It would seem that greedy doctors don't mind operating on you , putting you at risks to fill their pockets and pay for their million dollar vacation homes in the Hamptons!!! Double check everything your doctor tells you !!
I know that we come to trust that doctors really have our best interest at heart, but they can get caught up in wanting more and more, like an alcoholic, it can get out of control and too often , medical procedures that are very important to you, are routine for them.
If you have read the above link then you know that billions are lost to fraud that they know about!! You can bet that the dept of justice doesn't know about but a fraction of what goes on, and it isn't just money when it comes to our health!!!!
How horrible, now can you imagine how many lives have been ruined, or compromised because of mistakes that you never know about, or that were never reported, or that was covered up by the medical field?
Which brings up one subject, get copies of your records, you won't believe what is in some of them that shouldn't be. Look at the bills, see if the billing is correct, see if the diagnosis is correct, see what you sign, before you sign it.
Between 1988 and May 1992, this opthalmologist received $15.5 million from Medicare, primarily for cataract and eyelid surgeries that were not medically necessary or for which false billings were submitted.
http://www.usdoj.gov/opa/health/hcf1.htm
It would seem that greedy doctors don't mind operating on you , putting you at risks to fill their pockets and pay for their million dollar vacation homes in the Hamptons!!! Double check everything your doctor tells you !!
I know that we come to trust that doctors really have our best interest at heart, but they can get caught up in wanting more and more, like an alcoholic, it can get out of control and too often , medical procedures that are very important to you, are routine for them.
If you have read the above link then you know that billions are lost to fraud that they know about!! You can bet that the dept of justice doesn't know about but a fraction of what goes on, and it isn't just money when it comes to our health!!!!
Advocacy
Don't be a victim, when harm is done to you, or when you are over charged, when a wrong needs to be righted,, use all your avenues to gain the upper hand. Talk to your government representatives, talk to the people over the ones who have harmed you, keep going up the ladder.
Time does matter, there are time constraints if you are pursuing legal action, I know what happens, you get depressed and mope around and don't do anything, time runs out, you get caught up trying to find help to fix the problem, time runs out.
Get in a closet, scream ,yell, then come out and take action!
Find a friend who will keep your spirits high, have a laugh and give you encouragement.
Use the web, get the word out, find out your options, newspapers, the law, the BBB, whatever professional organization that can be involved, medical boards, health organizations, start a whole campaign in which you decide to empower yourself against whomever has caused you to be a victim!
Good Luck !
Time does matter, there are time constraints if you are pursuing legal action, I know what happens, you get depressed and mope around and don't do anything, time runs out, you get caught up trying to find help to fix the problem, time runs out.
Get in a closet, scream ,yell, then come out and take action!
Find a friend who will keep your spirits high, have a laugh and give you encouragement.
Use the web, get the word out, find out your options, newspapers, the law, the BBB, whatever professional organization that can be involved, medical boards, health organizations, start a whole campaign in which you decide to empower yourself against whomever has caused you to be a victim!
Good Luck !
I am a Downing McPeak vision center disaster
Don't let this happen to you!!!!!
Routine eye exam ruined my vision!
Before you ever let a doctor perform any laser , operation or almost anything, get a second opinion, and if you have any, any , special circumstances at all, see a specialist in that field!!! Double check every word , every procedure, look up the procedure, look up the doctors record.
I went in to see a Dr. Porter for a routine exam, after being talked into an operation that I shouldn't have had, I have ended up with my right eye vision going from a 20/40 -20/50 to worse than a 20/100 !!!!!!!! And left with a condition that very well make continue to make my vision worse!!!!
Always question your doctor about everything, although I thought I had asked the right questions, and to this day , I believe that he misled me, I should have questioned even more, never take it for granted that your doctor is putting your best interest above his wallet.
I have been told that it cannot be reversed, tried to clear up the complications from the surgery, couldn't.
A tech that performs tests on the machine that is supposed to tell what strength lens to implant, told me that they most likely did not set the machine for my condition, leaving me with the wrong strength lens, which is like having a permanent pair of glasses on that you can't take off, but is the wrong prescription, and cannot be replaced with the correct prescription.
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Routine eye exam ruined my vision!
Before you ever let a doctor perform any laser , operation or almost anything, get a second opinion, and if you have any, any , special circumstances at all, see a specialist in that field!!! Double check every word , every procedure, look up the procedure, look up the doctors record.
I went in to see a Dr. Porter for a routine exam, after being talked into an operation that I shouldn't have had, I have ended up with my right eye vision going from a 20/40 -20/50 to worse than a 20/100 !!!!!!!! And left with a condition that very well make continue to make my vision worse!!!!
Always question your doctor about everything, although I thought I had asked the right questions, and to this day , I believe that he misled me, I should have questioned even more, never take it for granted that your doctor is putting your best interest above his wallet.
I have been told that it cannot be reversed, tried to clear up the complications from the surgery, couldn't.
A tech that performs tests on the machine that is supposed to tell what strength lens to implant, told me that they most likely did not set the machine for my condition, leaving me with the wrong strength lens, which is like having a permanent pair of glasses on that you can't take off, but is the wrong prescription, and cannot be replaced with the correct prescription.
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