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Showing results for tags 'Medicare'.
I am internal med PA. I have Medicare patients with DMII that need diabetic shoes. CMMS requires that an MD or DO manages the patient's DM care altogether and does the foot exam. We do not have that luxury here and I have patient's that I am managing on Medicare that need shoes and I am sitting on the forms because I do not know what exactly to do. Does anyone else have this problem?
I am a 3.5-year experienced cardiology PA in a private single-MD practice. A month ago, I noticed that my MD was submitting a CPT code in his name for every single clinic patient I saw. He was sometimes putting the bill in the EMR before I finished my note and assessment and plan. He personally only saw my patients if they were new or complicated, accounting for 10% of my volume. At the time I saw all of these bills under his name, I was submitting paper superbills (for unrelated reasons). I thought this was just some misunderstanding where he didn't see me entering my own bills electronically, so he was putting in the billing under his name. I told my manager that he was double billing- his electronic CPT entry on top of my paper one. Could she please talk to him and ask him to stop? I did not want him to get himself in trouble and it seems to be a misunderstanding. Yes, oh yes she would... No, no no, he cannot do that. I made sure she had copies of the incident-to billing guidelines for Medicare in case he needed them. Days passed and I asked for an update. She said she was still discussing it with him. Then a week passed, and I asked again. She had spoken with him and shown him the incident-to guidelines. He said he was not going to stop billing all of my patients in his name. He said his personal lawyer advised him that he could do it. I told her that his personal lawyer is not my lawyer and he is kind of implicating me in fraudulent billing at this point and I don't want to be a part of it. She told him that if he refused to stop doing it, his PA might then quit. He told her, "ok." At this point it had progressed beyond a misunderstanding of billing to having full knowledge that what he is doing is against the rules and refusing to stop. She said she would speak with him again. We met again. "Well, there's good news and there's bad news. The good news is that he is going to stop billing all of your patients in his name. The bad news is, he wants you to look for a new job." I was totally stunned. This was not the outcome I was expecting. He did not clearly articulate to my manager why I was being asked to move on. I prepared my resignation letter to hand in at the end of my workday. Before the day ended, my MD spoke with me privately. He said his recommendation for me to find a new job was not based on money or billing or my job performance but on several other unrelated things. He did not want me to storm off the job today in anger. I could take my time finding my next job, he would provide recommendations, he would accommodate job interviews as needed. It was a positive discussion and I did not disclose that I was on the edge of quitting before he spoke with me. The next week was uneventful. At the end of each of my clinic days, I provided him with a list of the patients I saw that qualified as incident-to that he could bill in his name. On my last day of that week, he had a vacation scheduled so he was gone for the afternoon. When I finished seeing my last patient, my manager pulled me into her office and presented me with a letter from the MD. It said that this was my last working day and to finish all of my documentation by the end of the day. I would get 2 weeks severance, 4 weeks of unused paid vacation time. No explanation for why he was suddenly firing me. The manager did not see it coming. Perfectly timed for when he was going to the airport so he would not have to talk to me. The employee termination form required by my state says "reason for termination: wanted to replace PA with MD." My doctor has not spoken to me, emailed me, or anything else. That was a week and a half ago. I am currently looking for a job in the same area where this doctor is located. He is well-known and would certainly talk badly about me if he found out I was telling prospective employers the real reason why I got fired. My biggest obligation right now is to ensure I secure my next job. I have a 9 month old baby. Should I report the insurance fraud? If so, when? Does anyone have experience in reporting this or reporting an employer for firing them under such circumstances? I appreciate any comments or advice. I've learned to never underestimate a doctor's ego..... If he didn't fire me for finding the fraudulent billing, he definitely fired me for going to the manager about what he can and can't do.