Healthcare Fraud and Billing Issues
Medicare/Medicaid fraud investigations are rampant. "If you are aware of unethical practices, you have an affirmative duty to report that," says Rick Boothman. "Failure to report can expose you to discipline."
Physicians don't need to act on their own, though. "Regulations are complicated," he said. "I think a doctor needs a lawyer who is experienced in healthcare law to review the facts with a fresh set of eyes. Healthcare is a highly regulated profession, with plenty of risks across the board."
Ronald Chapman agrees. "When someone in a practice identifies a problem, our firm often will be called in to do a self-audit. We'll look at the billing practices. Let's say one doctor is consistently upcoding patient visits. We'll give an opinion, and the practice decides whether to turn that doctor in. Some do it and others don't. But the stakes are high. A partner's misdeeds can bleed over to everyone in the practice. I've seen a few practices break up over this issue."
"The regulations are highly complex, and even with the best of intentions, physicians can violate the statutes," he said. "I have law degree and a master's degree in healthcare law. I probably know only half of what I should. There are hundreds of new regulations every year. If it's determined that the practice is in violation, the penalty can be devastating. There may be a mandatory exclusion from participating in Medicare and Medicaid. Doctors can lose their licenses. Doctors have to ask themselves, 'Do I rat out my partner, or do I take the risk that I can be implicated as well?'"
If a partner is engaging in bilking Medicare, sexually harassing a patient, using drugs himself, or illegally prescribing narcotics, the entire practice is in jeopardy, said Armand Leone. "The bottom line is that the bad doctor has to be kicked out of the practice. If that doesn't happen, you should leave yourself. Practicing with that guy is just too dangerous."
The Impact of Testifying Against a Colleague
Testifying against a partner may be the ethical thing to do, but the results can be devastating. "The practice is essentially finished," says James Griffith. "The doctors will never trust each other again. It's also extremely awkward. Do you really want to ride the same elevator with the guy you testified against every day?"
Relationships will be forever strained. "It's like a husband and wife living in the same house after one of them files for divorce," said Armand Leone. "It's a very uncomfortable situation."
Michael Sacopulos sums it up this way. "If you testify against a colleague, you're definitely off the Christmas card list. The relationship can never been the same again."
Medscape Business of Medicine © 2016 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Mark Crane. Testify Against a Colleague? Kiss Your Friendship Goodbye - Medscape - Sep 26, 2016.