Wednesday, August 29, 2007

Profit-Seekers

You can't throw a rock in any ER in the country without hitting someone who has something to say about "drug-seekers" who, real or imagined (mostly imagined, to hear many chronic pain patients tell their side of the story) have become the bane of ER doctors everywhere. Seldom mentioned, however, is another brand of seeker, possessed of an even more deadly and insidious hunger for their drug of choice than the most hardened heroin addict. This is the profit-seeker, and his jones is for money and all it can buy. The hardcore profit-seeker will do anything, sell anything, kill anything to get it, and in his world everything—people, morals, ideals—is up for sale.

No studies have been done on the prevalence of greed disorder in the medical profession, but numerous studies have been done on the profit scamming this addiction often leads to, and it is clear the problem is enormous. Health care corporations are among the Top 20 greedophiles prosecuted under the False Claims Act. The Health Corporation of America, co-founded by members of Senator Bill Frist's family, was fined over $1.7 billion dollars under The False Claims Act and other statutes for Medicare/Medicaid fraud, the largest settlement for fraud in US history. Medicare fraud is estimated at over $33 billion a year, and doctors and hospitals defraud other insurance carriers as well. Some estimates by government and law enforcement agencies estimate the annual toll of healthcare fraud as high as 10 percent of total annual healthcare expedintures, or a staggering $170 billion dollars per year: over $170,000 per doctor on average.

Numerous doctors across the country have been indicted for scams involving kickbacks from MRI labs. For one example, see here. Fraudulent doctors also receive kickbacks from drug companies for prescribing particular drugs, as well as kickbacks for referring patients for surgery. Perhaps the most destructive category of medical fraud is the performance of unnecessary surgeries or other highly questionable procedures. While it is difficult to distinguish "necessary" from "unnecessary" surgeries, some estimates put the latter at 2..5 million a year, resulting in 11,600 deaths a year as well as severe pain and disability for many of the survivors. See here for some brief guidelines to avoid being victimized.

While no patient should ever be used or exploited or put at risk solely for the sake of profit, there is nothing wrong with doctors and hospitals making a profit per se. It can take many years of hard work and dedication to become a doctor, even for those who graduate in the bottom 5 percent of their class. Doctors are entitled to make a decent living commensurate with their experience and value same as anybody else, and no one should want to see doctors making the same wage as garbagemen or tax collectors. At the same time, it is clear that access to large amounts of money can and often does create a growing dependency on this drug that vastly exceeds the average dose that most Americans are able to get by on, leading to the sort of fraudulent profit-scamming behavior noted above.

One frequently encounters doctors on Internet medical blogs complaining about their incomes and how difficult it is to survive on them. Even doctors making $300,000 to $400,000 frequently rue their decision to go into medicine, rather than become $1 million-per-year bond traders on Wall Street. Such doctors often base their medical decisions on the bottom line, rather than on what is ethical or in the best interests of their patients. With the costs of medical care skyrocketing and medical expenses being the number one cause of bankruptcy in America, it is important that this dangerous addiction be curtailed before the medical system collapses in on itself. In the meantime, there are many warning signs that should raise a "red flag" that your doctor may be a profit-seeker.

Signs your doctor may be a profit-seeker:

  1. Is frequently red-faced and hyperventilating from running from one patient to the next, trying to maximize the number of patients he sees in a day. This is literally a "red" flag.
  2. Has knocked a nurse to the ground while sprinting to get to your exam room. The blood on the ground is another "red" flag.
  3. Has more physician's assistants (PAs) working for him than exam rooms to accommodate them.
  4. Has nurses doing bloodwork in the hallway. Another red flag.
  5. Sees walk-ins with good private insurance before Medicare patients with scheduled appointments.
  6. Insists you get MRIs and other scans at his hospital's lab, or at the one and only lab he recommends, telling you, "out-house scans bring outhouse results."
  7. Is on a first-name basis with the techs at that one and only lab he recommends.
  8. Dictates notes in your presence faster than that guy in the FedEx commercial.
  9. Demands payment up front and fails to deliver what he's already been paid for.
  10. Constantly complains that Medicare reimbursements of $70.00 for a 5-minute visit are too low.
  11. Frequently cancels appointments at the last minute without giving a reason, but charges you a penalty if you cancel an appointment, even with a valid reason.
  12. You frequently have to wait for 3 hours or more past your scheduled appointment time, but the doctor would have charged you a penalty had you been more than 5 minutes late for those same appointments.
  13. Knows more about his drug reps' hobbies than he does about your illness.
  14. Frequently complains about "socialized medicine."
  15. Charges exorbitant amounts and by the page for illegible, hand-written copies of your medical record.
  16. Doesn't have a single computer in the entire office.
  17. Complains that the 30 Tylenol #3 he gave you for spinal stenosis are more than enough for anyone with pain.
  18. Insists on prescribing one and only one medication for a particular condition, and has notepads, calendars, pens, wall-clocks and charts all emblazoned with that drug's logo.
  19. Makes you sign narcotic "contract" that specifies that you must undergo multiple injections from him, get MRIs from "Bob's" lab, a surgical evaluation from "Dr. Smith" (aka "best surgeon in the world"), see "Jane" at PT (aka "miracle worker"), and "Larry" for your monthly drug screening (aka Capt. Stickum), all before he will write you a script for 30 Vicodin.
The following list of warning signs of profit-seeking behavior have been derived from the PSEA's (Profit-Seeker Enforcement Agency) website:
  1. Unusual behavior in the exam room.
  2. Assertive personality, often demanding immediate gratification such as payment up front or sexual favors in exchange for meds.
  3. Unusual appearance - extremes of either slovenliness or being over-dressed. For example: wears cheap, threadbare polyester suits Goodwill would be ashamed to offer for sale, because he's too tightfisted to buy anything better. Alternately, wears $5,000, hand-made Italian suits because he can't afford anything better with those low Medicare reimbursements he's getting for the horde of patients in his waiting room.
  4. May show unusually poor knowledge of controlled substances and/or gives medical diagnosis based on non-textbook symptoms OR gives evasive or vague answers to questions regarding his diagnosis and expertise in his field.
  5. Reluctant or unwilling to provide referrals or copies of medical records to doctors he doesn't know. Usually has no regular transcription service, handwritten notes, and often no malpractice insurance.
  6. Will often insist on prescribing a specific drug and is reluctant to try a different drug.
  7. Generally has no interest in diagnosis, rushes you out the door with nothing but a script in hand, fails to keep appointments or order further diagnostic tests and refuses to refer to another practitioner for consultation.
  8. May exaggerate medical knowledge and/or simulate expertise and compassion.
  9. May exhibit mood disturbances, homicidal inclinations, lack of impulse control, thought disorders, and/or sexual aggressiveness.
  10. Cutaneous signs of drug abuse - skin tracks and related scars on the neck, axilla, forearm, wrist, foot and ankle. Such marks are usually multiple, hyper-pigmented and linear. New lesions may be inflamed. Shows signs of "pop" scars from subcutaneous injections. (No wonder he can't get by on $400,000 a year).
Modus Operandi Often Used by the Profit-Seeking Doctor Include:
  1. Must be paid right away.
  2. Schedules multiple appointments at the same time.
  3. Refuses to accept calls or come in after regular hours, even for dire emergencies.
  4. Feigns medical expertise about subjects he knows nothing about, such as abdominal or back pain, kidney stone, or migraine headache in an effort to avoid prescribing narcotic drugs.
  5. Feigns knowledge of psychological problems and their relation to pain, such as anxiety, insomnia, fatigue or depression in an effort to prescribe stimulants or anti-depressants in lieu of pain medication.
  6. States that specific non-narcotic analgesics work fine for most pain or that adverse reactions or allergies to these meds are rare to non-existent.
  7. Gives referrals to specific practitioners who are supposedly currently available but it takes months to get an appointment with them and he will not give a referral to a physician you can see sooner.
  8. States that triplicate prescription pad has been lost or stolen and so he can't give you anything stronger than Vicodin.
  9. Deceives the patient, such as by ordering refills less often than usually prescribed.
  10. Pressures the patient by feigning sympathy or guilt or by direct threats.
  11. Utilizes a child or an elderly person as an example of someone who can take pain better than you can.
Although profit-seeking in itself does not preclude the possibility your doctor will give you proper care, if you find yourself in the presence of a profit-seeking doctor, it may be in your best interest to find a physician who is more motivated by a desire to help people than to make a buck. While the Bible says it is easier for a camel to pass through the eye of a needle than for a rich man to get to Heaven, the hoops a chronic pain patient has to jump through to get proper care from such physicians are even more difficult to pass.

2 comments:

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