? Medicare fraud

[Chirley]

Hi, I went to see a neurologist for an initial consultation on Monday. I was referred last year but didn't want to go so I kept putting it off until my GP ran out of patience.

Anyway, besides being the rudest, most dismissive, least helpful doctor I have ever seen, she billed me for an initial consultation....45 minutes or longer but told me I would get a complete refund from Medicare ($245.00). It was as if she expected me to be grateful. The problem is that I was with her for a maximum of 8 minutes before she refused to take over my care. I paid this account at the time and didn't notice that the item number was for a long consult until the next day when I was going to send the account to Medicare.

I rang the doctors office immediately and told them there had been a mistake and I had not had a long consultation. I was told that someone would call me back, but they didn't. So I rang again today and I was told that it didn't matter because I wouldn't be out of pocket. I told them it was fraud and I WAS NOT going submit that invoice to Medicare knowing it was criminal.

Now I'm in a position where I have paid the account but can't claim my refund because I would be knowingly committing a fraud which would benefit the doctor. I am scrupulously honest and this would go against my life principles.

To make things worse, I checked out the "rate my doctor" website and there were a number of other patients who found her rude and unhelpful but also charged them for a long consultation when she shouldn't have.

I'm considering reporting her for fraud. Would that be appropriate?

Regards

Chirley

[Neil Cuadra]

Chirley,

I would submit the paperwork to Medicare and enclose a letter asking whether it's a problem that the appointment was less than 10 minutes and may have been coded as a longer appointment. Once it's in the system I'd phone or email them to followup and ask how the claim will be handled and whether you need to do provide any other information.

In other words, I would treat it as a possible mistake, not assume that I knew it was fraud, and make clear that you are asking for advice or direction. You shouldn't have to be the middle of a matter between the doctor and Medicare. If for some reason the billing is correct (e.g., if appointment times are always rounded up) or they decide not to act on what you told them then you'll get your reimbursement. If it gets treated as a billing error then they'll presumably give you instructions for anything you need to do about it. And if they consider it possible fraud then they're in charge of investigating it. In that way, you'll be honest about providing the facts without cheating yourself out of reimbursement.

Does that sound sensible?

[Birgitta-A]

Hi Chirley,
Neurologists can be rude but as far as I know it is uncommon that they don't examine their patients meticulously. That doctor must have decided initially that she was going to refuse to take over your care.

As Neil wrote you can treat it as a possible mistake but if she won't make an excuse to you and Medicare you should go futher - she has obviously done the same "mistake" before.

I think we should look at "rank your doctor" websites every time we go to a new doctor just to get some info.

How are you doing?
Kind regards
Birgitta-A

[triumphe64]

Chirley,

Are there special reporting requirements in Australia?

[Chirley]

Thanks for your replies. I was wondering if I was alleging fraud because I was annoyed with her and her rudeness or whether it was really fraud. Sometimes I question my own thinking because I know I have some cognitive problems.

I did ring the doctors surgery twice to give them a chance to admit to a mistake but I received a phone call from them yesterday afternoon and the secretary told me that the doctor stands by her item number and fee. Apparently the doctor feels that she had to look at an MRI report (not the MRI, just the one page report) and send a letter back to my GP and that's how she justified the fee.

I had no choice but to report the doctor to Medicare for fraud. I feel very anxious about having done this.

I haven't been having any treatment for about two months because the treatment for the allergy to the treatment () was horrible. I decided to have a break and see how I felt about returning to daycare and doctors and ambulances and drugs etc etc after I had a respite. The attitude and demeanour of the neurologist the other day has confirmed in my own mind that I am definitely developing some sort of anxiety disorder about illness, doctors, hospitals etc. I think I probably need some professional help with this but that would mean attending more medical appointments and I just can't do it! I have had episodes of feeling like I can't breathe and I've had to sit in the middle of the lawn at three in the morning just to stop the panic of not getting enough breath.

On a purely physical level, I'm surprised I'm doing as well as I am without treatment but I can feel that I am deteriorating a little over the last three weeks or so. I have had a lot of neuropathic pain for the last year or so and it's wearing me down. I asked my old neurologist for pain relief and he refused. I asked my GP for help and he wouldn't prescribe anything without a neurologists approval. So I went to this new neurologist and she said "your GP will deal with that". So a year later I'm still in pain, I still have no treatment and I am seriously thinking of self medicating with whatever I can get my hands on.

Besides the panic attacks (), I have enjoyed my last two months of freedom and no matter what happens in the future, it was worth it.

Regards

Chirley

I found this description of Tim number 132 ........the doctor didn't meet any of the criteria


CONSULTANT PHYSICIAN (OTHER THAN IN PSYCHIATRY) REFERRED PATIENT TREATMENT AND MANAGEMENT PLAN - SURGERY OR HOSPITAL

Professional attendance of at least 45 minutes duration for an initial assessment of a patient with at least two morbidities (this can include complex congenital, developmental and behavioural disorders), where the patient is referred by a referring practitioner, and where
a) assessment is undertaken that covers:
- a comprehensive history, including psychosocial history and medication review;
- comprehensive multi or detailed single organ system assessment;
- the formulation of differential diagnoses; and
b) a consultant physician treatment and management plan of significant complexity is developed and provided to the referring practitioner that involves:
- an opinion on diagnosis and risk assessment
- treatment options and decisions
- medication recommendations

Not being an attendance on a patient in respect of whom, an attendance under items 110, 116 and 119 has been received on the same day by the same consultant physician.

Not being an attendance on the patient in respect of whom, in the preceding 12 months, payment has been made under this item for attendance by the same consultant physician.

[Neil Cuadra]

Chirley,

A certain level of anxiety is perfectly rational in the face of long-term illness, but what you have described sounds more serious. I encourage you to get help for the anxiety and panic attacks. It's ironic and unfortunate that one of the results of anxiety, hyper-vigilance, or irrational bouts of fear is difficulty in seeking help for those problems.

You've had so little control over your life in recent years. These symptoms are further reducing your ability to enjoy any freedom. I know that getting help involves another medical consultation, just what you'd rather not have, but if you get through the initial steps (finding somebody you can establish a good rapport with, accepting the need for help and possible treatment, and getting to those first appointments) then you could get past this or greatly reduce the symptoms.

So much depends on finding good doctors, doesn't it? That's an issue we all face.

[Birgitta-A]

Hi Chirley,
You have been so brave all these years you have been fighting your disease. The medical people have made so many mistakes - for example not examining your copper level initially - and you have been forced to take care of yourself.

There must be other neurologists who treat their patients with respect.

If you don't feel like trying with a psychiatrist for the anxiety disorder you could try to get help from the net - look for CBT. Perhaps you already know CBT that have quite good results for depression and anxiety disoreders.
Kind regards
Birgitta-A

[Sarah H]

If you are in Logan Queensland you should drop in at the Logan city Centre (Woolies Triple C) medical centre on the corner out the front. Get medicated for your panic attacks and they have an on-site psychologist. All Medicare funded and not fraudulent. You will never know how you really feel if you are feeling physical symptoms of panic. You sound to me like you really need a break from yourself and when you calm down you will feel a lot better!

[Chirley]

Hi, yes, I put in an official complaint but as far as I know nothing happened. I do know that a website that rates doctors re popularity has her rating as extremely poorly and mentions her overcharging for consultations constantly. It doesn't surprise me that doctors get away with fraud....people don't like to think of them as being anything but honest and upstanding pillars of the community.

I now have a very good neurologist and a wonderful physician. i have limited contact with any other doctors including my GP. My Neuro pain has diminished by itself over the course of my disease (how lucky am I?) By limiting the amount of medical appointments I feel I am coping a lot better with my illness. I'm not living so much in my "sick" role, so to speak.