The new (and old) scam going on at Urgent Care clinics...

[Cideous]

Happened a while back to a PA who worked opposite of me.  Here's how it works....

1.  Patient comes into the clinic, almost always with a boyfriend/husband etc.

2.  Patient reports some allergy, usually seasonal, and asks for a Decadron shot.  States, "it's what they always give me and it works..."

3.  Patient gets the shot, waits for the MA/Nurse/Tech who gave the shot to leave the room.

4.  If sitting in a chair the patient "falls" out of the chair pretending to pass out.  Even if told to lay on the bed, patient pretends to pass out and roll off the bed, making a large amount of noise when they supposedly hit the ground.  Usually they throw a phone down or spill their purse loudly etc.  The boyfriend/husband significant other screams out and is now the official "Witness" of the event who Juuuuust couldn't catch them in time before they so "violently" crashed to the ground...unprotected.

5.  The staff rushes into the room to find the patient on the floor doing their best post syncopal acting job.  Most are pretty good at it.  Utube is a great teacher.

6.  Patient immediately "regains consciousness" and starts complaining of their back, neck, shoulder, knee are hurting and they are in 10/10 pain.  They do this so the provider will have to document 10/10 in the post incident chart report.

 

They are then treated as a trauma with X-Rays etc. further documenting their "fall".  As you document the event, you are building their case for them.  Usually at that point the area medical director is called and gets involved.  Accusations are made by the "patient" and the boyfriend/husband that the clinic staff and provider are at fault for giving a shot and not "protecting" the patient. Really, how many exam tables in UC have guard rails?  I've never seen them.

 

The "victim" threatens to get a lawyer and sue for damages.  Corporate freaks out and immediately settles out of court.  Usually for $25k-$50k cash money.  In some more aggressive cases, the victim team will have a scam lawyer on retainer who will actually file a malpractice lawsuit forcing the malpractice insurance company to get involved.  These people are usually going for over $200k+ and willing to wait for their payday. Since most UC's use MA's or X-Ray techs to give shots, it further weakens your case and will make the provider 100% responsible.  An RN/LVN will be able to put up a little defense, but it still falls on the provider on duty.

 

 

Takeaways:

1.  If possible have a shot room close to where you are sitting or have a nurse/MA view them at all times.  Or at least only give shots where you can leave a door open, which is tough because the scammer is now on to this and will say they are shy and can you "close the door" during their visits.

2.  Try and document on every patient given a shot that the patient does not have a history of passing out.

3.  Talk to your area medical director ahead of time about this scenario and what to do if it happens.

4.  Try and have at least 1-2 rooms in your UC with guard rails and give all your shots there.

 

Long story short.  There is not much we can do.  There is a 99% chance they will get paid before it ever goes to court and you will take the hit.  At least if corporate settles before a lawsuit is filed, you can claim ignorance as to the outcome for the next 20 years of your career having to answer the, "Have you ever been sued, or had money paid out to a patient....." question on every single job application going forward.

The girl PA this happened to where I was working was despondent and ended up quitting/getting pushed out.  It was very stressful for her.

Just an FYI for the many providers out there doing UC.  Good Luck to us all.

[thinkertdm]

thanks for the update!  I agree, not much you can do about someone who is untruthful or trying to game the system.

However, practicing good medicine can cover you a bit:

-think before you prescribe/order any therapy.  What am I treating, why am I treating it this way, what alternatives are there, is this is the safest/best way for the patient.  I understand that in an UC setting there is pressure to see more faster, but this is basic stuff, and slow down.

The key words above is "is this what they always do for me".  At that point, you need to stop.  While it is handy to know what has worked in the past, it by no means absolves you of responsibility if something goes wrong.  Writing "patient claimed it worked in the past" in your note isn't a magic shield. 

There are times when administering a medication in the clinic are necessary and times it is not.  Think before you do it. 

Lastly, document your thought process.  Have dot phrases if you need to.  This documentation may save your career, mine has saved mine. 

 

[GetMeOuttaThisMess]

Or just don’t give steroid shots, and instead give po. Check out half-lives of each and multiple x5 to reach therapeutic level. There isn’t a significant difference in my book.

 

[ventana]

shot of decadron - yeah nope....  

 

maybe (and I mean maybe) some po pred....

[Cideous]

I generally give Medrol Dose Packs, but anyone who has worked in UC knows that Steroid shots are the big money maker.  Care Now in DFW is famous for giving 8 and 80.  8mg of Decadron and 80 of Solu-medrol.  They given dozens if not more every day.

Point is, if you work in UC you will get pressured into these, at least at most corporate clinics.  Toradol works the same way.

 

Just be on the lookout for this scam.  It is becoming very common.  

[ohiovolffemtp]

Yes, when I worked in UC I used to order decadron PO and was told that it had to be ordered IM.  This was not because of any lack of awareness of the PO efficacy but rather to capture the billing for giving an IM injection.

[ventana]

doing a higher level of care (IM over PO) is unethical 

 

I have done ER and Urgent care (small practice) and the very first time someone told me to do IM shots for someone not in dire straights (airway) i would politely decline 

 

it is just wrong to essentially steal from our patients to pad our bottom line.  

[rev ronin]

3 hours ago, ventana said:

it is just wrong to essentially steal from our patients to pad our bottom line.  

Yes, but this is America, where how much money you have matters far more than how you got it.  Where we don't actually cover the Hippocratic oath or ethics in any depth in medical school.  Where the government has to force pharmaceutical "gift" disclosure.  So yeah, I'm not surprised that (gasp) certain clinics would do useless but not necessarily harmful things to increase payments.