Is this legal? Part 2

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I'm sick and tired of all this BS with "Buy and Bill" bone stims. I know for a fact some of the clinics in Va. are indeed billing Federal Plans. This whole practice of buy and bill bone stimulators is a bunch of BS! Selling a clinic a $150 Bone Stim for $1,600.00 and having them turn around and bill $3,200.00 to insurance companies is a PRIME example of what is wrong with Healthcare and why costs are so sky high.

Add to the fact that this profit is a "kick back" to the practice which gives them incentive to place more Bone Stimulators even on patients who do not need them.
 






Anonymous said:
I'm sick and tired of all this BS with "Buy and Bill" bone stims. I know for a fact some of the clinics in Va. are indeed billing Federal Plans. This whole practice of buy and bill bone stimulators is a bunch of BS! Selling a clinic a $150 Bone Stim for $1,600.00 and having them turn around and bill $3,200.00 to insurance companies is a PRIME example of what is wrong with Healthcare and why costs are so sky high.

Add to the fact that this profit is a "kick back" to the practice which gives them incentive to place more Bone Stimulators even on patients who do not need them.
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Be a whistleblower on this account you know about in Va.and make a million or two.
 






This, and many posts on this particular message board have a similar theme and seem to be lacking something that I have had as a recurring theme in parenting: You are responsible for your actions.

All of the things that have come to light about the BGS investigations and the outcomes point to Sales Reps making a decision to knowingly break the law by modifying notes, changing dates, photo-copying Rx's, etc. Let's be real: People knew these actions were against the law and would result in a false claim being made to a Federal program, but chose to do these things anyway.

Also, the pressure to make numbers is real and will be for anyone in sales. We see from prior posts and from the news that certain former VPs of Sales have been convicted of fostering these illegal practices.

The days of justifying illegal short-cuts to make numbers are gone, at least for anyone that wants to stay out of jail.

It's true and rediculous that Congress can have lobbyists give them trips, gifts, etc., while the same actions violate the anti-kickback statute with a health care provider. But, that's how it works.

So, I for one, come back to my first statement: Take responsibility for your actions, stop blaming others and either follow the laws or change professions, but stop making excuses and complaints over justifying illegal behavior. For sure, vent and get it out of your system, but then move one.

One man's opinion.
 






Are offices allowed to bill commercial insurance if we service a patient in their clinic? I'm relatively new as a TM and this was recently brought to my attention. I am not referring to a buy and bill program, but simply the fitting. What are the requirements?
 






If Orthofix is billing insurance, then Orthofix can fit the patient. IF the physician is buying the stim and billing, then Orthofix cannot fit the patient, as this would be a free service for the physician and likely constitute an anti-kickback statute violation.
 






Anonymous said:
If Orthofix is billing insurance, then Orthofix can fit the patient. IF the physician is buying the stim and billing, then Orthofix cannot fit the patient, as this would be a free service for the physician and likely constitute an anti-kickback statute violation.
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well then. you still have reps "fitting patients" in the hospitals that buy and bill.
 






Anonymous said:
well then. you still have reps "fitting patients" in the hospitals that buy and bill.
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as long as the hospital does not bill for the "application" it should not be an issue.
Here's the PRoblem people:

Nobody in management will answer these questions so we have had a lot of reps "in the dark and shooting blind" on some of these issues. For example, I bet many people don't know that they shouldn't be "applying" stims on patients in clinics who buy and bill. WTF? Even if the clinic does not bill APPLICATION??
 






Rhode Island Physician’s Assistant Sentenced to 12 Months for Taking Kickbacks from Medical Device Company



JULY 19, 2012


BOSTON - A Rhode Island man was sentenced today in federal court for taking kickbacks.

Michael Cobb, 42, was sentenced by U.S. District Judge George A. O’Toole to one year incarceration (six months in prison, six months home confinement), to be followed by two years of supervised release and a $3,000 fine. Cobb was also ordered to forfeit $10,000 of proceeds from the offense to the federal government. Cobb pleaded guilty to violating the Anti-Kickback law on April 19, 2012.

Between 2004 and 2011, Cobb, a physician’s assistant, took kickbacks from Orthofix Inc., a medical device company, in return for ordering Orthofix’s device. Orthofix manufactures bone growth stimulators, which are externally-worn medical devices that emit electromagnetic waves that help regenerate bone cells. Cobb was a physician’s assistant for a neurosurgeon in Rhode Island who prescribed bone growth stimulators for patients who underwent spinal fusion surgery. The surgeon had no preference as to which company’s bone growth stimulator was used, believing that there were no clinical differences amongst the stimulators on the market. The surgeon left this decision to Cobb, who was in a position to direct the stimulator business to whichever medical device company he chose. Between 2004 and 2011, Orthofix paid Cobb for each bone growth stimulator that was ordered by the surgeon in payments ranging from $50 to $300. Cobb never disclosed to the surgeon that he was taking these payments, and the surgeon would not have authorized the arrangement. Cobb was paid approximately $120,000 between 2004 and 2011 for bone growth stimulator orders. In return, Cobb steered more than a $1 million of reimbursement from insurance carriers to Orthofix, including approximately $350,000 in payments from federal insurance carriers.

In addition, Cobb committed perjury during his testimony before a grand jury when he falsely denied that he was ever paid by a territory manager who worked for Orthofix, and he lied by testifying that the surgeon he worked for was aware of the financial arrangement. Cobb admitted that, through his perjury, he obstructed the government’s investigation, as part of his guilty plea.


In addition to the Cobb sentence, the investigation concerning Orthofix has to date resulted in a number of felony charges against Orthofix as well as company executives and employees, including the following:

•On July 23, 2012, a plea and sentencing hearing is scheduled with respect to Orthofix’s plea to obstructing a federal audit, in violation of 18 U.S.C. § 1516. Orthofix has agreed to pay over $42 million to resolve criminal and civil liability arising from the illegal promotion of its bone growth stimulators (U.S. v. Orthofix, 12-cr-10169-WGY);
• On December 14, 2011, Mitchell Salzman, pled guilty to perjury in violation of 18 U.S.C. §1623 while he was a Regional Manager for Orthofix (U.S. v. Salzman, 11-CR-10385-RWZ);
• On March 22, 2012, Derrick Field pled guilty to health care fraud in violation of 18 U.S.C. §1347 while he was a Territory Manager for Orthofix (U.S. v. Field, 12-CR-10057-JAT);
• On April 9, 2012, Thomas Guerrieri pled guilty to paying kickbacks in violation of 42 U.S.C. §1320a-7b while he was Vice President of Orthofix (U.S. v. Guerrieri, 12-CR-10061-RWZ);
• On May 11, 2012, Michael McKay pled guilty to health care fraud in violation of 18 U.S.C. §1347 while he was a Territory Manager for Orthofix (U.S. v. McKay, 12-CR-10129-DJC).

The investigation is ongoing.

United States Attorney Carmen M. Ortiz; Susan J. Waddell, Special Agent in Charge of the Department of Health and Human Services, Office of Inspector General; and Leigh-Alistair Barzey, Resident Agent in Charge of the Defense Criminal Investigative Service made the announcement today. The case was prosecuted by Assistant U.S. Attorney David S. Schumacher and Jeremy M. Sternberg of Ortiz’s Health Care Fraud Unit.
 






Anonymous said:
well then. you still have reps "fitting patients" in the hospitals that buy and bill.
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Guys: re fitting a patient for a stim purchased by a hospital, physician or private practice, Orthofix cannot fit those patients, unless there is a separate fitting agreement with that customer, where The customer pays separately for that service, as the company would be giving away a free service and this would likely be viewed as an inducement.
 


















Anonymous said:
I find it had to believe companies are allowing this to go on. It would have to be rogue reps knowingly walking down a fire pit. I fail to believe this is going on as we speak
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I would like to think that all Bone Stim reps are now following the Medicare/Government policies to the letter.

However, there are still Bone Stim reps who are NOT including an Operative Report on a Non-Union that was just fixed. However, it will catch up as hospitals are going to Computerized Documentation. Medicare will then deny when they see that the patient had an ORIF on top of a bone stim (double dipping). Technically, you are suppose to wait 90 days AFTER ORIF. Instead you have Ofix reps slapping on stims immediately post op.
 






Anonymous said:
I find it had to believe companies are allowing this to go on. It would have to be rogue reps knowingly walking down a fire pit. I fail to believe this is going on as we speak
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Oh but it is. All the reps (with all the companies) who have a stock and bill agreement with a clinic or hospital. Reps in the OR and on the hospital floors delivering bone stims and fitting. Reps are getting hospitals to purchase bone stims around a grand below average insurance reimbursement and then encouraging purchasing to bill at list price in hopes to get even more reimbursement.

Yeah, yeah, capitalism is great and love it. However, this practice is very shady. Insurance companies are catching on to the fact that the stims are being fitted post ORIF.
 






Anonymous said:
Oh but it is. All the reps (with all the companies) who have a stock and bill agreement with a clinic or hospital. Reps in the OR and on the hospital floors delivering bone stims and fitting. Reps are getting hospitals to purchase bone stims around a grand below average insurance reimbursement and then encouraging purchasing to bill at list price in hopes to get even more reimbursement.

Yeah, yeah, capitalism is great and love it. However, this practice is very shady. Insurance companies are catching on to the fact that the stims are being fitted post ORIF.
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The whole bone stim scam will go down....reps, better look out for their own skin. People are going to jail. Companies going to get hurt and look for reps to throw under bus, as they already have. Stop the fraud. You are being watched.
 






Anonymous said:
I would like to think that all Bone Stim reps are now following the Medicare/Government policies to the letter.

However, there are still Bone Stim reps who are NOT including an Operative Report on a Non-Union that was just fixed. However, it will catch up as hospitals are going to Computerized Documentation. Medicare will then deny when they see that the patient had an ORIF on top of a bone stim (double dipping). Technically, you are suppose to wait 90 days AFTER ORIF. Instead you have Ofix reps slapping on stims immediately post op.
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Not just Ofix doing this. You have EBI and reps in the OR who slap one on the patient right after an ORIF, non-union revision. No discussion with the patient, just a deal made by him (Biomet rep) and the surgeon in the OR. Then the groggy patient is visited by the EBI rep in Post Op and goes home wearing the stim with the rep's phone number in case they have questions.
Usually the rep's cherry pick the patient who has a secondary, so they don't scream about getting a copay bill.
 






Anonymous said:
Not just Ofix doing this. You have EBI and reps in the OR who slap one on the patient right after an ORIF, non-union revision. No discussion with the patient, just a deal made by him (Biomet rep) and the surgeon in the OR. Then the groggy patient is visited by the EBI rep in Post Op and goes home wearing the stim with the rep's phone number in case they have questions.
Usually the rep's cherry pick the patient who has a secondary, so they don't scream about getting a copay bill.
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for some reason this story reminds me of someone waking up in a bathtub full of ice, with a note saying, "your kidney has been harvested, please call 911"
 






Anonymous said:
In my many years of experience I can say that I've never offered a doc or their office anything at anytime. I have been approached on a few occasions, however, where the doctor is demanding to get paid for using our stims.

One office asked if there was any way to make money, such as fitting the patients in house.

Many offices have asked about stock and bill as DJO brought it to their attention that we weren't "sharing" the potential revenue stream.

Another office flat out said that if we were unable to make help them get paid they were going somewhere else. They did. I am happy for their decision and ultimately feel it's best to steer clear of them. They would never burn for their actions but my head would be rolling if I assisted them in their immoral behaviors.
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I know many reps who I feel confident in saying, have never paid a Dr. or member of the staff for using a bone stimulator. When asked if they can bill for a "fitting", the reply should be, "if the dr. or a pa fits the patient, I do not know if the payers will reimburse; that is not my expertise" The benefit of helping your patients in healing from a non-union without possible additional surgery, will be a reward of intrinsic value, meaning that you will have a satisfied and very grateful patient who will bring in new patients.
 


















Anonymous said:
Someone beat me to it.
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was there a whistleblower involved in VA? Read through the case, pretty wild

http://www.justice.gov/usao/ma/news/2014/April/TerrellIlenesentencingPR.html

Look at this carnage from the DOJ website:


" In addition to the Terrell sentence, the Orthofix investigation has to date resulted in a number of felony charges against employees and contractors of Orthofix, including the following:

On Dec. 14, 2012, Orthofix was convicted of obstruction of a federal audit and paid approximately $42 million in criminal fines and civil payments, and was sentenced to probation for five years;
On Jan. 22, 2013, Thomas Guerrieri, the former Orthofix Vice President of Sales, was sentenced to eight months in prison and was ordered to pay $50,000 in forfeiture and fines for paying kickbacks to health care professionals;
On July 19, 2012, Michael Cobb, a physician’s assistant, was sentenced to six months in prison, six months home confinement and ordered to forfeit $10,000 and pay a $3,000 fine for accepting kickbacks from Orthofix;
On Aug. 9, 2013, Hunter Rigsby, a former Orthofix Territory Manager, was sentenced to eight months in prison and ordered to pay $75,000 in criminal fines and forfeiture for committing Medicare fraud and paying kickbacks;
On Jan. 31, 2013, Mitchell Salzman, a former Orthofix Regional Manager, was sentenced to three months of home confinement and one year of probation for committing perjury;
On Jan. 9, 2013, Derrick Field, a former Orthofix Territory Manager, was sentenced to five months of home confinement as part of a two year probation sentence, in addition to paying $44,000 in forfeiture and fines for committing health care fraud;
On Jan. 23, 2013, Michael McKay, a former Orthofix Territory Manager, was sentenced to three months home confinement, one year probation and paid $13,000 in forfeiture and fines for committing health care fraud;
On Sept. 28, 2012, Brian Racey, a former Orthofix Territory Manager, was sentenced to one day in prison, six month of home confinement, two years of supervised release, and a $2,500 fine for committing health care fraud; and
Michael Jenkins, a former Orthofix Territory Manager, has agreed to plead guilty to committing health care fraud.

United States Attorney Carmen M. Ortiz and Philip Coyne, Special Agent in Charge of the Department of Health and Human Services, Office of Inspector General, Office of Investigations, made the announcement. The case is being prosecuted by Assistant U.S. Attorneys David S. Schumacher and Miranda Hooker of Ortiz’s Health Care Fraud Unit."
 






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