Should I bring this up to my employers or not?
I work in pediatric healthcare as a benefit specialist, I bill insurance and work with patients and their finances etc. Recently a patient of ours was dismissed from therapy because she was not improving (and we needed the spot for someone who would likely improve) though that was not mentioned to anyone but me. I felt that was unfair, as there are many children at our practice that do not have the potential to improve, but we still see them. I spoke to my employers and they told me it was fraud to bill insurance for medical services that were not likely to produce results or improvements in the patient’s condition. I understand that. However, the aforementioned girl was still turned away for therapy, and multiple patients still remain treated though its the same scenario. Should I speak to my employers about this or just do what I’m told? I bill the insurance, so am I commiting fraud? And is it my business that we are treating patients unfairly?
And yes SUSIE I can read medical progress reports written by our therapists and decipher whether the patient is improving or not… and besides that, my employer straight out told me of multiple patients that continue to be treated with no hope of progress.
It is only fraud if you are billing the insurance company for services not rendered. If you treated the patient, you can bill them. I think it shows good character that you want to do something about the unfair treatment of patients. Try and talk to your employer again, and if they do not listen go above them- such as if your office is part of a larger medical group. Sounds as if there is another possible reason for dismissal of the patient if they are keeping others around in the same unimproved condition.
Amanda D
13 Jan 09 at 7:02 pm
You have the medical expertise to determine the potential outcome of therapy for each of the patients in your practice?
Gee I thought that people went to medical school to learn that skill – and all you have to do is be a medical biller!
Susie D
16 Jan 09 at 11:52 am
OMG, I really feel for you. I can’t answer your question but I sincerely hope that someone can. It has all the earmarks of those “whistle-blower” movies. I can only remark upon it from a parent’s point of view. I had to go up against the PT providers on the same issue and at that time could use a federal law about equal treatment. I don’t remember what number it was, it came in during the Kennedy era, and all I had to do was mention it, not threaten use of it, and, because I was an informed parent, I got what I wanted for my son. My husband and I felt bad for others who were less well educated on the law and their rights, and told those we could about it, but…
Good luck, dear. You are such a caring person, I hope that this turns out well for you and others involved.
Casperia
17 Jan 09 at 6:51 am