No one questions the right of any payor to audit its payments to detect fraud, patterns of abuse or patterns of error. Around $5.4 billion were returned to the Medicare coffers as a result of audits by the contractors to Medicare for these audits. But let’s dig a little deeper into this. What if I…
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‘Those Guidelines Don’t Apply to Me’
I was taking a peer review call from a pediatrician. For those of you who don’t know, a request for “peer review” means a physician-to-physician conversation about something that was denied by an insurance company. In this case, I had denied payment to a hospital (as a medical director for an insurer) for a readmission…
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Should the Public Hold Physicians to a Higher Standard?
Dr. Oz has defended his right to present what he has to say to the general public. Broadcast in 118 countries and to more than 3 million viewers, he defends his right to tell the audience about the products featured on his show. His response to criticism is that he does not sell or endorse…
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Compromising on Principles
“Well, you know, Gus, principles are expensive.” I had just complained to my attorney that justice was not being served, and there were hard held principles being violated by the actions of another person. He was willing to pursue the matter, but warning me that it could get expensive, and the outcome would not be…
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