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| Dear Friend,
Double billing and double use led to double trouble for a famed plastic surgeon.
Although it’s certainly preferable to being skinned alive, the U.S. Department of Justice recently announced a $23.9 million civil False Claims Act settlement with a Beverly Hills plastic surgeon, his medical practices, his businessman son, and their billing company to resolve allegations that they violated the False Claims Act by submitting or causing the submission of false claims to both Medicare and Medicaid.
Originating with multiple whistleblower actions filed by a podiatrist and others working with the plastic surgeon and his medical practice, the settlement resolves allegations that Dr. Joel Aronowitz and his related entities, Joel A. Aronowitz, M.D., a medical corporation, Tower Multi-Specialty Medical Group, Tower Wound Care Center of Santa Monica, Inc., Tower Outpatient Surgery Center, Inc., and Tower Medical Billing Solutions, together with Dr. Aronowitz’s son, Daniel Aronowitz, falsified the place of service for skin grafts and billed multiple times for single-use skin substitute products.
As to the place of service allegations, the government contended that the settling parties made claims stating that wound-care procedures involving single-use skin substitutes that were actually performed in one location, for example, in the medical practice setting, were performed in both the medical practice setting and in the ASC setting.
Additionally, the government alleged that Dr. Aronowitz failed to properly dispose of unused portions of single-use skin graft materials and, instead, used them in later procedures involving other Medicare and Medicaid beneficiaries, resulting in thousands of instances of double billing.
In addition to the monetary settlement, the parties agreed that Dr. Aronowitz and Tower Multi-Specialty Medical Group will be excluded from Medicare, Medicaid, and all other federal health care programs for a period of 15 years, and that Daniel Aronowitz, who was the CEO of Tower Medical Billing Solutions and the Director of Revenue Cycle Management for Tower Wound Care Center of Santa Monica, will be excluded for three years.
Note that the whistleblowers’ and the government’s allegation were just that, allegations, and that the settlement resolves them without any admission of liability and without any determination of liability.
The general takeaways for you
1. Be extremely diligent when submitting claims for reimbursement to any third party payor, whether or not it’s a federal health care program. Unfortunately, this rule applies even if you’re not the one finalizing the submission of claims: Physicians suffer from the false claims made negligently or intentionally by office, management company, and billing company staff.
2. It’s almost universally the case that whistleblowers come from within your practice or organization, including other physicians with whom you are associated, such as within your medical practice or within your surgery center, or from business associates such as outside billing services, a/k/a revenue cycle management companies.
3. False Claims Act civil settlements are not necessarily the end of any particular story because they do not resolve potential criminal liability for the same underlying acts. You can settle civil allegations in the morning and be arrested before the end of lunch.
4. Engage in an active, not a passive, compliance program, which is far more than having a “compliance plan”.
5. False Claims Act civil settlement agreements are not generally made public, but the one in the Aronowitz matter was. Contact me if you’d like a pdf copy. |
| | Wednesday - A Medical Group in Motion - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript: People often cite Newton's First Law as something akin to "an object in motion tends to stay in motion with the same speed and in the same direction."
That reminds me of many medical groups that believe that their relationships will continue and continue. For example, their relationship with referring physicians or with a facility under, say, an exclusive contract.
But that same "law" contains a caveat: The object only stays in motion until it is acted upon by an unbalanced force.
In business life there are constant unbalanced forces. They are called competition, creative destruction and plain old unbalanced individuals. Their mission, known or unknown, is to insert themselves or someone else into "your" relationships.
Many medical groups exhibit a second Newtonian tendency. They devote all of their "motion" to the day-to-day duties of patient care. It then becomes difficult for them, from the inside, to create the force necessary to change direction, whether outright in respect of embarking on a new strategy, or even only to the extent that they make the necessary effort away from patient care activities to consider their future and necessary strategies to get there.
For many of you, it's time to break free of your current situation.
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| | | Listen to the podcast here, or just keep reading for the transcript.
Bob, not his real name, was talking about one of his early post college jobs.
Just after graduation, he sold financial products over the phone. He was required to make 30 outbound cold calls each day.
So, he recounted, he’d get in first thing in the morning, make his 30 calls and then leave.
Success was measured in the number of calls - that was what his employer was paying him to do - not in the dollars of actual sales.
What are you incentivizing your employees or independent contractors to do? And what if those incentives are driving them to not do other things that are far more essential for your business? Or, even worse, what if those incentives are driving them to do things that are clearly detrimental to your business?
Consider these examples:
An anesthesia group pays its physicians for quick “turnaround times,” the lag between sequential cases in an operating room. But patients complain to the hospital that the anesthesiologists are rushed, rude, and not interested in their concerns.
A fast food restaurant uses a timer to measure the time the drive-through window employee takes on each customer interaction, seeking to reduce it to the absolute minimum in order to speed the pace of the line. The “winning” employee of the week is paid a significant, when measured against hourly pay, bonus. But customers complain that they are not getting the correct order, that items are left out, and that the employees are rude.
A medical group pays each of its four physician owners an equal salary package to reward their supposedly equal contributions to the group's success. One, or perhaps more, of the owners quickly figure out that the "game" is now to figure out how to work less for the same pay.
Compensation plans are far more than a part of the toolset for attracting and retaining partners and employees. Everyone knows that they incentivize performance. But too few take the time and effort to consider what their plan will also incentivize or de-incentivize.
Speeding the flow of customers through the fast food line or from pre-op to the O.R. and then to the recovery room may well be a good thing from one or even many perspectives. But if the cost of doing it is destroying your customer base, then it’s a very shortsighted gain.
Devising the right compensation plan is a complex undertaking. It involves far more than just "pay."
So, ask yourself, what are you actually incentivizing?
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| | Help Us Help You With Helpful Content
What tailored content would you most like to see during this
time? How can we focus on solutions to your most pressing strategic concerns?
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| | | | We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back.
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| In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy Free.
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| | | | Whenever you're ready, here are 4 ways I can help you and your business:
1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line.
4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly. |
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