Sunday, January 24, 2016

The Other Side of the Same Coin

      The other take in the media over the million dollar billing flap by the ER doctors at SMC is the Channel 7 headline that it was an honest mistake caused by an out of town billing company.
       Print coverage made it sound more nefarious. 
       "Honest mistake" or not, nobody likes it when a ministerial dispute becomes news. Sometimes these things never are found out about and in some cases they get tamped down.
            http://www.wwnytv.com/news/local/Did-ER-Doctors-Make-A-1-Million-Honest-Mistake-366241931.html

9 comments:

Anonymous said...

This was no honest mistake when they were told repeatedly that the modifier was not applicable in our zip code and kept using it "to see if they would still get paid." After speaking with someone who knows a lot about billing I found out that the money paid from this modifier comes as a separate deposit, not co-mingled in with other payments and so they knew they were still getting paid under the illegal modifier. Yes, Tricare should have stopped paying but this is BIG government and sometimes it takes them a while to catch up, sad but true.
Samaritan and Tirene are most certainly going to tamp this down as they are about to do the ask for a new multi million dollar endowment campaign. Bad press makes peoples wallet go shut. Must stop the bad press because these fine ladies would never rip off their own community, would they? They are so involved and caring. Caring, Sharing and Leading - that is Samaritan - just not sure what they are leading us to.

Anonymous said...

Would anyone expect them to say anything else? Of coarse, the Doctors are going to blame someone else once they get caught with their hand in the cookie jar. Medicare, Medicaid and now Tri-care fraud runs into the billions each year. While there is a token effort to detect it, prosecutions are few. It's a bit like speeding on the interstate. Most times you get away with it.

That's the major problem with single payer health insurance. The payee, the government in this case, has little incentive to vigorously go after fraud, particularly if it involves the party in power core constituencies. Private, profit seeking firms in a competitive environment have every incentive to go after fraud, as it affects the bottom line.

Anonymous said...

The interesting thing about many of the comments here on the story is that they related to leadership or lack thereof. Poor practice and delivery of services. Highly compensated, top-heavy staff. Bad medicine. A non-profit with a profit motive.

Not saying they are all true... just saying its interesting.

Anonymous said...

Try living in Ogdensburg and dealing with an inept emercency care facility like Claxton Hepburn medical center.. If you enter this facility you can count on a minimum of a three hour wait to see a doctor if in fact you even see one. Very good staff locally provided but very very poor doctors. In fact I think their entire doctor staff are in Canada and only come in if called. The ER is run by PAs and NP..
I know for a fact I had a friend that experienced a heart attack and they didnt see him and he left six hours later. Another friend went in over a dog bite, and went home four hours later only to go to Potsdam Hospital for treatment.. Doctors and hospital expect big money for little or no service however.

Anonymous said...

This is the most asinine story that Perrykos has tried to pus yet.
The "insurance company didn't catch the problem for how long? They let the person they were sending the cash to, bill them on the honor system?
I wasted my last tear on the drug smugglers who got what they had coming. So now I didn't have any tears left for this story.

Anonymous said...

I just wish they would pay the contractors.

Anonymous said...

Carman has that much in the bank. And Krista can cut back on her self promotion campaign. Pooof, the money will be repaid.

Anonymous said...

Cut staff!!!! ED admission wait times soar to 10 hours - oh wait, that would be an IMPROVEMENT.

The board should clean house... but they can't - too much dirty laundry.

Anonymous said...

Oh Mr. Graham, this is not over. The WDT is doing a follow up article and things are going to get interesting. Seems they want to know about the other 11 -12 practices referenced and when they quit using the modifier and why. Rumor has it, they stopped years before the ER. Bad ER, doctor's need to be accountable, can't wait to see how SMC spins this....
You might want to refresh this thread come Monday or Tuesday, it will be more than relevant.