Tuesday, February 13, 2007

Medicare Fraud Raises Its Ugly Head...2/21

One of the biggest payers in the Paris mix is Medicare. Because we are so dependant on it, the thought of a Medicare audit strikes fear into the hearts of CEOs and billing personnel as well.

Well, the spectre of doom might be standing at Essent's door. The hospital is trying to pass this off as Dr. Xavier's responsibility.... Yeah, they'd love it if that were the case, but I think that we have to look deeper.

Can we say incompetence? These are mostly the same folks that forgot to bill patients for an entire year while the Minor Care Clinic was operational. These are the same folks who turned over billing for EKGs to RR when they were losing money at it, and RR made money. These are the same people that failed to pre-cert for surgeries, and to get provider numbers for locum CRNAs.

But, we also have to look at the corporate guiding lights--Hud and his crew came from Columbia/HCA to a great extent, and others, which have had Medicare billing problems before. These are also the people that feel that getting fines for non-compliance is cheaper than paying a director's salary.

Maybe Medicare will change their minds....


Anonymous said...

I imagine it's like non-certified ultrasound techs doing vascular studies, and billing medicare.

Anonymous said...

E$$ent was billing for comorbid conditions that were essentially not an issue on the rehab unit. This helped boost their reimbursement, but guess what? THEY GOT CAUGHT BY MEDICATRE! Now they want to blame Dr. Xavier for their billing problems!

E$$ent stripped Dr. Xavier of his medical directorship of the rehab unit. They've also hired a group of rehab doctors to provide medical directorship over rehab. Dr. Xavier hasn't resigned and remains one of the most competent and qualified physicians on staff. If you're a doctor and you have a rehab consult just write "rehab consult WITH DR. XAVIER" to ensure that Dr. Xavier is the one to see the patient rather than the hired guns.

Anonymous said...

It's funny how they pick the best ones to be their fall guys. The ones that actually care for the pt. and give it 100% is going to get the blame, almost without fail.

Dr. Xavier, you have my vote for a job well done. You care about what is good for the patient, and I applaud you.

As for administration, there are people out there who went to school for coding. Hire them. Pay them well. Let them be accountable, and leave the doctors out of it. They are supposed to take care of patients, not find ways to help you make money.

Anonymous said...

If Christus had been more careful in overseeing a lot of the little things, Essent wouldn't be here.

For a guy that draws down as much as he does, you would think that Dr. Royer would have been able to turn this place around. Apparently he had the same attitude that the staff did.

Of course, attitude is communicated from the top down.

Anonymous said...

Joe Xavier is a heck of a nice guy, a dedicated physician, and far too good to be a sacrificial goat to the gods of Essent.


Anonymous said...

Dr. X is a super doctor. He really cares about the patients. Wonder how long he will choose to remain in Paris. Paris is going noplace except down. The political leadership in this town is all about selfish pursuit of their personal agendas and money. That is why the city government and the hospital situation is screwed up over the last three years.

Anonymous said...

I refuse to believe that Essent looks at this blog. If they do, then they are indeed complete idiots for not acting on the information contained herein. Hud is a complete DUD!!! Why didn't they blame Cheryl Perry? She's the one that makes all the policies around here,even if she is an uneducated bumbling idiot...sorry,I'm not supposed to give away trade secrets. Anyway,Cheryl has her nose in everything so how could anything happen without her knowledge? I say she's to blame. Which makes as much sense as blaming Dr. X!

Anonymous said...


Anonymous said...


Anonymous said...

Theryl Perry needs to go back and review her policies she revised back around Jan 17, 2007!! I see Andrews name right under hers. I dont remember Andrew being there at that time. Come on Theryl, pull it out

Anonymous said...

Wanna know why essent is laying off people??????

They are trying to make this place look profitable so they can sell it!!!!!!!!!!!!!!!!!!!!!!!!!

Please lay me offf Essent..... Please... Do me a favor... Ill take the 400 a week unemployment for free...

Anonymous said...

Oh they could always tell the truth:

"We underestimated this small town, and we thought that since it was so far away from another hospital, we would just corner the market, and these people would just put up with anything.

WE were wrong, and lost money."

But, Hud is never wrong....frank

Anonymous said...

Dr X is a great doctor but you all know that if it is not documented it was not done in Medicare's eyes. Dr X was in the wrong by his poor documentation that did not support what was being billed. Not say that Dr X is a great doctor but everyone knows you have to have the supporting documentation.

Ah, but there's the rub. If the "policy" was to upcode charges, then the documentation would not support them. If the upcoding was based on the comorbidity issue mentioned by 5:27 AM, then he might not have been evaluating that.

The hospital coders might have automatically upcoded, and certainly then the documentation might not have covered. Watch out Hud, how many rehab beds does E$$ent own???....frank

Anonymous said...

To me, the whole coding thing should be out of the Dr.'s and nurses hands. We already have enough to worry about with malpractice, then we have to worry about coding, correctly, and the wrath of medicare.

The doctors and nurses have 100 agencies that we have to be compliant with, I just don't see where we get to deal with the coding thing as well. The classes are about as fun and interesting as watching paint dry. It gives me a headache and something else to worry about.

My firm opinion is they are spreading Dr.'s and Nurses too thin with this crap--meanwhile who is taking care of the sick?

Anonymous said...

Regardless of WHO E$$ent wants to blame or hang out to dry (which seems to be their forte).....

The facts are that Medicare fraud responsibilities are spread out and inclusive of the organization and people involved in it. If the appropriate watchdog committees and compliance measures were NOT in line (we all know this was not the case) adhered to, employees trained in,etc, etc, then in Medicare's eye, you are guilty, PERIOD! No name calling, or laying the blame on ONE individual. Recompense is gathered from many, including the buffoonish corporation that felt THEY were above compliance of any kind. This applies to CEO's, HR directors, right down to the billing/coding staff. The fines are stiff and on a per incident occurrence, per day level. And the nasty little secret is that Medicare let's you hang yourself for awhile until you're good and caught. Once the mechanism for scrutiny and audting is engaged, it gets really nasty, thorough and expensive. NOTHING will be missed, nor forgiven, especially when found that the preventative measures E$$ent has/had were insufficiently made, kept and practiced. Hud won't be able to simply walk off on this one, OR file bankruptcy, it don't happen that way, the Feds GET their money, and place those responsible in jail.......period. And I truly hope they skin, tan and hang Hud's and cronies hides on the wall for all to see. Think Hud bucked up against the wrong folks this time, and no amount of two-steppin', sweet talkin', paper shredding, fast writin' on policies will get his butt and buddies off the hook. Can you say "RUED, SCREWED AND TATOOED"?

My, my, perhaps there is gonna be a little justice for these schmoes after all.

Anonymous said...

In re: the last post-

One can only hope there would be justice. Since Hud is supposed to be the bigtime healthcare know-it-all, he should know better. However, I'm not sure he may try to find a fall guy to hang it on.

He may need to mind his Ps and Qs with Medicare, 'cause the ultimate penalty, IIRC, is taking away Medicare reimbursement. For a rural facility like PRMC, that's the death penalty. And who's to say that Medicare, much like a hog rooting for truffles, may not dig deeper into the other faclilties for discrepancies.

I don't think the J-school dropouts at the Snooze could ignore that bit of news.

Anonymous said...

Cheryl should change her name to Monica. More fitting, one would think.

Anonymous said...

Dear 8:04 AM:

You are so correct that in medicare's eyes, if it's not documented,
it didn't happen.

But, you seem to have the cart before the horse. In other words
should Dr. Xavier be documenting to support Ess'ent's billing? or should
Essent be billing in support of Dr. Xavier's documentation? Medicare is equally clear on this also, and that is that the billing should
support the documentation, and not the other way around.

The hospital bills for it's rehab services and Dr. Xavier bills
separately for his physician services. So the question that would explain all is: "Is Dr. Xavier being personally audited for his physician services?" The answer to that is a resounding "NO!"

So again 8:04, thanks for your comment, I'm glad I could clear up
your confusion on the issue of billing.

Anonymous said...

At a max $10,000 per incident and possible triple damages, this could make that $650,000 shortfall look like pocket change.

Anonymous said...

Dear 9:04pm,

There is no issue is not about billing. If you ever read Dr X's notes there is no billing to be done or very limited. Since you are so smart in billing issues maybe you should step up and take the lead. Like I said, Dr X is a great doctor but sub-par in documentation. There are many other physicians and nurses in the same boat. Essent should have had a case manager that was reviewing his charts and there should be documentation of the education given for improper documentation. So in light of all things where does this fall back to? ESSENT!

Anonymous said...

Hey 8:29,

Not just 'not registered for vascular', but not even registered, period.