Medicare Fraud

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Anonymous said:
But sometimes, a bone stim fails so a surgeon has to fixate. I understand that reps should not order a bone stim days before surgery is scheduled. It's called double dipping. Technically, if a patient has a bone stimulator applied Prior to a non-union repair via ORIF, that is Double Dipping the tax payer. Once that non-union has been fixed or grafted then it's technically not a nonunion any more- it's fixed.

With all that being said, many managers coach reps to get the order post surgery and apply after ORIF or grafting....

So technically, what is right?
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That whole line of thinking is total bullshit. if the patient has risk factors that surgery is risky and probably compromised or even a waste of time and money. At $3000 you are almost always likely saving the system money in the long run.
 






Anonymous said:
That whole line of thinking is total bullshit. if the patient has risk factors that surgery is risky and probably compromised or even a waste of time and money. At $3000 you are almost always likely saving the system money in the long run.
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We are saving the system IF the bone stim is used INSTEAD of surgery. we are not indicated as adjunct- which means bone stim plus surgery before 90 days.

Do agree that there are a lot of unnecessary ORIF's but until we have data and indication, one does have to be careful promoting as adjunct to ORIF. Just ask our legal department
 






But that is a fault of the system. If the patient is a smoker, diabetic, or the fracture is hanging around for months ORIF will probably fail. Surgery or revision surgery in a lot of cases is a shitty answer. If the patient heals one month faster the system wins. And why the hell should a patient endure surgery if they can be healed non-invasively. It's just dumb and the taxpayers are not being 'saved'. not by a long shot.
 






Anonymous said:
But that is a fault of the system. If the patient is a smoker, diabetic, or the fracture is hanging around for months ORIF will probably fail. Surgery or revision surgery in a lot of cases is a shitty answer. If the patient heals one month faster the system wins. And why the hell should a patient endure surgery if they can be healed non-invasively. It's just dumb and the taxpayers are not being 'saved'. not by a long shot.
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You have to prove it through studies. And there are many diabetics, smokers who do heal post ORIF. To defute a standard of care is naive and irresponsible. Especially if a fracture is displaced; surgeons have been trained to fix. Exogen has not been proven to accelerate healing post ORIF/IMN. It very well could be the fixation or bone graft that induces fast healing. The Trust Trial was suppose to prove it, but the studied was stopped.
 












Anonymous said:
But that is a fault of the system. If the patient is a smoker, diabetic, or the fracture is hanging around for months ORIF will probably fail. Surgery or revision surgery in a lot of cases is a shitty answer. If the patient heals one month faster the system wins. And why the hell should a patient endure surgery if they can be healed non-invasively. It's just dumb and the taxpayers are not being 'saved'. not by a long shot.
Click to expand...

A fault of the system is having reps like you promote Exogen added to ORIF. It has not been proven that Exogen is the hero in accelerating healing of nonunion As a surgical adjunct. Exogen has only been proven to accelerate healing of acute fractures.

It's not the systems fault that our attempted study was halted. You have to prove outcomes with studies and get an indication before you can promote this to surgeons.
 






Anonymous said:
But sometimes, a bone stim fails so a surgeon has to fixate. I understand that reps should not order a bone stim days before surgery is scheduled. It's called double dipping. Technically, if a patient has a bone stimulator applied Prior to a non-union repair via ORIF, that is Double Dipping the tax payer. Once that non-union has been fixed or grafted then it's technically not a nonunion any more- it's fixed.

With all that being said, many managers coach reps to get the order post surgery and apply after ORIF or grafting....

So technically, what is right?
Click to expand...

To wait 90 days post any surgical intervention. According to CMS
 






Anonymous said:
A fault of the system is having reps like you promote Exogen added to ORIF. It has not been proven that Exogen is the hero in accelerating healing of nonunion As a surgical adjunct. Exogen has only been proven to accelerate healing of acute fractures.

It's not the systems fault that our attempted study was halted. You have to prove outcomes with studies and get an indication before you can promote this to surgeons.
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Yes. You are correct
 






Anonymous said:
The Orthofix fraud that was being perpetrated involved their reps creating, changing and forging notes. Apparently the doctor in Virginia was helping them do this. I think this is worlds apart from what you are talking about here, and honestly I find it strange that you would link the two together.
That being said, we will all agree with you that it's either conservative + stim _or_ ORIF. The Orthofix reps in my area treat fresh fractures but they seem to bill the hospitals for all of these. Or do I thought - maybe they are changing notes like they do in the South!
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You are naive to think that reps here don't alter notes or fabricate notes with made up co-morbidities.
 






Anonymous said:
You are naive to think that reps here don't alter notes or fabricate notes with made up co-morbidities.
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People who get caught doing that with proof or an investigation could serve Jail time. Call the Fraud Hotlines if it's Medicaid or Medicare or both. Need evidence, which would be easy in obtaining charts and comparing to patient history. Please turn in. These are the things that are wrong with our medical system. It's Tax payer dollars.
 
























What is interesting is I know some people that did go to compliance to blow the whistle on some in leadership concerning writing and faking notes. They had emails to prove it-and absolutely nothing was done. All of those involved are still employed! It just proves the lack of professionalism and carelessness in the company. I am shocked that there hasn't been a major whistleblower suit-there is certainly plenty of shadiness to work with!
 






Anonymous said:
What is interesting is I know some people that did go to compliance to blow the whistle on some in leadership concerning writing and faking notes. They had emails to prove it-and absolutely nothing was done. All of those involved are still employed! It just proves the lack of professionalism and carelessness in the company. I am shocked that there hasn't been a major whistleblower suit-there is certainly plenty of shadiness to work with!
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Compliance (within the company) is the wrong place to go.
 






Anonymous said:
But sometimes, a bone stim fails so a surgeon has to fixate. I understand that reps should not order a bone stim days before surgery is scheduled. It's called double dipping. Technically, if a patient has a bone stimulator applied Prior to a non-union repair via ORIF, that is Double Dipping the tax payer. Once that non-union has been fixed or grafted then it's technically not a nonunion any more- it's fixed.

With all that being said, many managers coach reps to get the order post surgery and apply after ORIF or grafting....

So technically, what is right?
Click to expand...

Its done quite a bit.
 






Anonymous said:
What about writing your own letters of medical necessity, having the office scan on office letter head? Is that wrong? Seriously asking, my Dos thinks its a best practice.
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I work for a very ethical DME company now and if the practice above is done for Medicare or any federal patient; it's considered FRAUD. Your DOS is telling you to commit fraud. Do Not do it.
 
























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