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Thursday, January 19, 2017

Another Insurance Scam Story....I'm so tired of this.

I'm Fired Up

It's been a while since I posted, but yesterday something happened which fired me up, and not it a good way.  One of my patients came in and told me about some lady he heard of, who had a car accident a few weeks ago.  This person lives somewhere in Cutler Ridge, which is South West Dade County, FL.

So, she had an accident, and she is now treating at a chiro office with her boyfriend, who was the passenger.  So, for a few minutes we were discussing the way the PIP works, and difference between first party insurance, and the at fault party's insurance, etc.  And then, out of the blue, my patient asked me about the $2000 dollars that this woman got, and the $2000 her boyfriend got, UP FRONT for their "settlement", at the chiro office.  The reason my patient was asking about this, is because, as an ex insurance utilization employee, he was wondering why these two people were also told to come in to the office five times a week, for what appeared to him to be a minor car accident.

Now, I am a pretty calm person 99% of the time.  Very mellow.  Maybe, even too mellow.

Considering the unbelievable nature of this story, I actually think I controlled myself fairly well.  But, I think that by the end of the visit with my patient, he was a little rattled up, because he has never seen this side of me.

As a doctor who has been practicing chiropractic for over 20 years now, I feel I have a good grasp of the way these scams work.  And, if you are reading this and you are not either a doctor or a lawyer, and you are maybe a little naive, I will explain to you what is actually happening at this office in Miami with these patients, and probably a lot of other patients who are coming in for treatment over there.

This is likely the sequence of events and facts that surround this crime:

The patients are in their car and are in an accident.  Maybe the accident was staged, maybe not.

The injured patients called one of the lawyers who advertise on TV during the time when the Jerry Springer Show, or similar is on.  Or, maybe they called 411-Pain or one of the other ones that are popular these days,  The patients are referred to a doctor's office and are told that the office will take very good care of them.

The doctor's office looks at the "case" and realizes the at-fault party has a small or bad insurance company, or maybe that at-fault vehicle has no insurance at all.   However, the patients have one of the larger carrier well known insurance companies like Allstate, Geico, State Farm, or Progressive.     The office quickly sees that the patients have a very bad case because of the bad coverage on the other side, and the patient's policy has no uninsured motorist coverage, but the two patients do have $10,000 in coverage, EACH, in fact.

Since the doctor's office knows that if the patients find out they have a bad case, they wont come in for treatment, the office offers the patients up front cash, to come in, and come in frequently and a lot, so the office can quickly bill through the entire insurance benefit until its exhausted.  The possibility is that that this inducement or kickback is also provided when the patient actually knows they have no case. Yes, lots of times these patient's come in expecting this cash kickback, because they heard that some offices do this.  In other words, they shop around for it, until they find an office who will pay them, and an office that will pay the most.

Either way the kickback is provided because the doctor knows that the patient will have no "incentive to treat" because they really dont have pain, but they just want money.

So, the doctor's office pays out $4000 and then bills $20,000.  This leaves the office with $16,000.

Yes, this scam happens.  Not always, but it does happen.  For those who are reading this and are thinking that all personal injury is a scam, you are wrong about that.  Please dont group the legit medical and legal offices with total scam insurance fraud scheme offices.  It is unfortunate, but there are bad players in every profession.

The truth is that there are patients who are injured and who are treated correctly, legally, professionally, and are helped.  You just have to make sure you go to a good office, and if you are using an attorney to help compensate you for your injury, you go to a good, and legit attorney.

If you are a patient and are tempted to accept a kickback from the medical office or someone working outside the medical office, be aware, that not only is the office committing insurance fraud, but YOU are too.  This means that you will be subject to prosecution and face the possibility of jail time, the same as the person who gave you the money.  And if you think you will not get caught, think again.  The insurance companies and the insurance fraud task force know the offices who are doing this, and they are waiting for the right time to rush into the office with guns drawn, and with the news crew present, to make an example out of you, and place your face and name on the front page of the news paper and the 5 o'clock news.

I have been treating patients who have been injured in car accidents for over 20 years.  If you would like information, please call my office and I would be happy to discuss how I can help you, the right way.

Professionally yours,
Dr. Alan Himmel

Friday, September 16, 2016

How to Properly Manage a Personal Injury Patient

Proper management of an injury patient is an important part of patient care that should not be overlooked.  When a new patient comes into my office, I always make sure that the patient has a clear understanding of the process.

The procedure involves detailed documentation of the patient's history, which includes finding out about prior injuries, car accidents, prior medical treatment for any body part, even if the treated body part was not accident related.  The reason behind this, is that all parties involved will want to know whether the patient's new injury overlaps with any prior medically treated areas of the patient's body.

Moreover, included in the history are any other medical conditions, as well as family history, and prescriptions currently being taken.  From this, you can learn a lot.  For example, a patient recently told me that she has a family history of aneurysm resulting in death to her sister and father. Chiropractors should never overlook this history, and blatantly do cervical adjustments on these types of patients.

At the end of the initial visit, there should be an initial report written and each subsequent visit with the doctor should be documented in standard SOAP form.  The patient always signs the chart note for the visit.  No signature and no visit ever happened.

I almost always make sure the patient is quickly referred to an orthopedic specialist or his medical doctor who could also diagnose emergency medical condition if necessary.  Emergency medical condition or EMC, is specific to Florida, and is required if the patient has a more serious injury, and its purpose is that it frees up the patient's full insurance benefit, if extensive treatment is necessary.  The insurance company is counting on the fact that the patient will not have an EMC and will only be responsible for 25% of the claim.  Without it, the insurance company takes away 75% of the patents insurance benefit.

Soft tissue injuries are better diagnosed with objective tests, like MRI.  Sometimes, X-rays are ordered if fracture or dislocation is suspected.  Most of the time however, x-rays do not turn up injury in patients that have injuries that are soft tissue in nature.  Over the years, I have seen some broken ribs, sternums, and bones in the hands and feet, but this is rare.  X-rays have shown dislocations, over the years,

Depending on the frequency of the visit, the course of treatment can vary between a couple months and upward of 6 months or more.

Any other referrals will be made if necessary, including orthopedic doctors, neurologists, podiatrists, mental health doctors, etc.

Finally, a report is generated when the patient is released from standard care, at maximum medical improvement, MMI.  If there is a request for an impairment rating, I will provide the rating in the report, and forward the report to the attorney who is helping to resolve any claims.

During this whole process, COMMUNICATION is key so that everyone is on the same page, and nothing is missed.

I have been seeing mainly personal injury type patients for 20+ years.  If you have been involved in a car accident, don't hesitate.  Please call my office to schedule your first visit.  If you are a lawyer and have a client who you think could benefit from an experienced doctor in regard to accident care, I will love to see that person.  It is NOT my goal to provide GOOD care to my patients;  it IS my goal to provide EXCELLENT care to my patients.

Alan Himmel, DC PA.