Re: Billing practices/Kris in VA

[Guest guest]

The pain clinic I have been going to was FINALLY nailed for their shoddy billing

practices.  Due to issues with billing Tricare, they were fined $2 million. 

Kris in VA

[Guest guest]

> The pain clinic I have been going to was FINALLY nailed for their shoddy

billing practices. Due to issues with billing Tricare, they were fined $2

million.

>

> Kris in VA,

>

Tricare will bust them and when the physicians do not adhere to the memoradums,

they will sue. The Doctors knowingly sign this form that states they cannot

charge but the allowable charges and I have seen many, many, I audited that

think they can. As I said, when I was on a two week tour in San and

auditing a oxygen supply compay (cannot say their name), they quit sending

respiratory therapists out monthly and the driver just dropped off the oxygen.

They did this because current trend states it was not necessary but this company

had signed a memoradum that states that a respiratory therapist will evaluate

the cliient monthly.

I found over three million dollars this company had overcharged with dead

patients still receiving oxygen tanks and the family leaving them in the room,

they double billed with other insurance companies, and patients were not being

assessed for progress. Just think-two weeks and three million dollars.

The Pharmacuetical Contract I audited was the same way, workers would order

brand medication when generic was not available and when it came in, the forgot

to change the information and the computer system and workers kept ordering the

more expensive medications. I went through all the medications dispensed and

looked to see if alternatives and generics could be put on the formulary. This

is sad as every day the workers do an end of day report that states the status

of what they ordered and if there were any problems and then SHOULD have faxed

or e-mail to distributors /contractors we had a contract with and a person

employed at the disburtition center was supposed to correct.

But the worker orderind did not do this, When I showed them how much this add

the charges they were surprised as they just looked at it as ten dollars here

and there when they orderd.

This is the type of attitude that causes us to pay millions in taxes. I really

enjoyed doing this and since I was a Reservist it was funny as the base

contracting did not know me and was wondering who this Major (that was me)

was that was finding all this errors. I created checklists for the workers to

use on the contract folders to make sure they were checking the companies for

compliance of the contract.

I even was doing training when the Hospital Auditors were there and the Colonel

had me auditing the contracts before them to make sure there were no errors.

These hospital auditors were starting to leave and were doing a after action

report and had a write up on an item I just happened to have in a folder and

corrected by finding an invoice that it had been paid correctly. I brought it to

them and they asked me to fax it to them. The workers there thanked me profusely

and it was one of those times I felt I had purpose.

I believe that the government or any organization that has a contract should

also have an individual assigned to it to manage it and audit it for compliance.

These contracts last at least five years at a time and since Kris mentioned

Tricare, I was amazed at our current pharmacuetical contractor, Express Script

and Walgreens are in " warfare " and they are dropping Walgreens Jan 1 so we have

to find another pharmacy. I hate it as Walgreens is 1/4 mile down the road.

Tricare is a governmental organization thata usually does not put up with this

and can go back three years and collect monies. This happened when they put in

the third party payments as members were using their primary insurance and

Tricare secondary and keeping the money and not reporting it. That was a huge

over all.

Aetna, Medicare,Blue Cross Blue Shield, all have policy guidelines and adherence

requiremens and they are posted online. Always know you have the right to report

discrepicies and appeal any determinations, this is YOUR healthcare and don't

depend on someone else that might not know how to get you care. I got my husband

a brain surgeo that does less invasive brain surgery for his colloidial cyst and

the insurance did not. My husband will be flown out by helicopter if his cyst

blocks his cerebral fluid and the San Hospital has the brain staff on

call twenty four hours.

If I had depended on someone else within the insurance company, there is no

telling what I would have got. Just remember you deserve good care. I'll get off

the soap box now : )

Thanks for sharing Kris. I always feel the need to run out of a medical office

when I give my name to the receptionist, Ms. and they ask me to spell that

and then talk to me as I am hard of hearing bending over like I am an old lady

and they are about nineteen. This girl actually asked me how to work the fax

machine in their office, but she is pretty . Bennie

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