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| | Dear Friend,
Telemedicine is the future.
Fraudulent telemedicine is apparently already here.
Is anyone actually shocked?
A few weeks ago, the U.S. Department of Justice, in coordination with the OIG and the FBI, announced the fruit of their coordinated law enforcement action targeting fraudulent genetic cancer testing by dozens of cancer genetic testing labs and dozens of telemedicine companies, and various individuals, including doctors, in connection with an alleged combined $2.1 billion Medicare scam.
Additionally, CMS’s Center for Program Integrity announced its action against other cancer genetic testing companies and medical professionals in connection with an additional $1.7 billion in alleged fake Medicare claims.
In total, those actions were part of a September push by the federal government that resulted in charges against 380 individuals who allegedly billed federal health care programs for billions in fraudulent charges.
In connection with the telemedicine prosecutions, the government alleged that cancer genetic testing labs paid illegal kickbacks and bribes in exchange for the referral of Medicare beneficiaries. The recipients were said to be medical professionals working with fraudulent telemedicine companies.
It’s claimed that some conspirators controlled a telemarketing network that lured hundreds of thousands of elderly or disabled patients into the trap. The government alleges that some of the defendants paid doctors to prescribe cancer genetic testing without any patient interaction or with only a brief telephone conversation with patients they had never met or seen.
Telemedicine may be new, but healthcare scams are as old as one can imagine. Elixirs and tonics of all variety sold out of the back of a covered wagon were simply less sophisticated versions of preying on the fears and hopes of those via modern means.
Among the defendants charged in these various task force actions are:
Richard Garipoli, 42, of Loxahatchee, Florida, the owner of telemedicine company Lotus Health LLC. He’s charged with conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks, and substantive counts of health care fraud and receiving kickbacks.
Jamie Simmons, 62, a resident of South Carolina, and the owner of telemedicine companies MedSymphony LLC and Meetmydocc LLC in Ft. Lauderdale, Florida. Simmons is charged with conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks, and substantive counts of health care fraud and receiving kickbacks.
Khalid Satary, 47, of Suwanee, Georgia, was charged based on his role in an alleged scheme to solicit medically unnecessary cancer genetic tests from Medicare beneficiaries through telemarketing and “health fairs.”
Daniel R. Canchola, M.D., 49, of Flower Mound, Texas, was charged for his alleged referral of Medicare beneficiaries for medically unnecessary cancer screening genetic tests. The government charged Canchola with receiving illegal kickbacks and bribes for the screening orders he signed without examining or speaking to patients and in the absence of any physician-patient relationship.
Sekhar Rao, M.D., 48, and Vinay Parameswara, M.D., 46, both of Austin, Texas, were charged for their role in alleged referrals of TRICARE beneficiaries for medically unnecessary cancer screening genetic tests and toxicology tests. The government claims Rao and Parameswara did not examine or speak with the beneficiaries for whom they signed testing orders, and that there was no physician-patient relationship.
Money, big money, is tempting. I know because I’ve counseled many clients in connection with telemedicine “ventures” paying what they must have thought was money from heaven.
Yes, telemedicine has many valid applications. Violation of the AKS and committing fraud are not among them.
And, the money’s not from heaven. It’s from hell.
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| | Tuesday - Success in Motion Video: What? Pay My Team More Than I'm Obligated?
Watch Tuesday's video here, or just keep reading below for a slightly polished transcript: |
| | I want to talk to you about something that perhaps, on its face, might sound a bit shocking to you - paying your team more than you’re contractually obligated to. Some of you (or all of you) are probably saying, “Why in hell would I want to do that?”
Here's the answer:
In order to have your team all pulling in the same direction, understanding that they’ve got to go above and beyond the call of duty, to work extra hours, to come in on a weekend to finish something, to stay at work late to take care of a project that needs to be taken care of – you should be distributing bonuses to them.
And, not on an annual basis, but when there’s a win.
No matter how you might measure a win (perhaps the award of a new contract to the group, the expansion of the business to take over another facility, or the acquisition of another business), people appreciate a pat on the back and being told they’ve done a good job.
But when you cut through all the crap, what they appreciate more is money. As in "show me the cash."
So, share with them. Show them, actually show them, how important they are to the team’s success.
Demonstrate that and see how hard they pull for you.
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| | Wednesday - Medical Group Minute Video: Augmented Unreality and Medical Group Success
Watch the video here, or just keep reading below for a slightly polished transcript:
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| A week ago while having dinner at a conference, I sat across from two women - I’ll give a quick shout-out to Judy and Devonna without identifying them by their last names, in case they don’t want the shout-out.
We were talking about the people that we had separately observed at concerts who, instead of actually watching the concert, were filming the concert on their phones. In essence, they weren’t watching the concert live, they were watching a video screen of the concert.
Is that even watching a concert live? I’m not sure. It doesn’t seem so. You’re focusing your experience on a screen instead of everything that’s going on around you.
Which makes me wonder if that same phenomenon of focusing on a very narrow object or viewpoint doesn’t also impact many others in healthcare. Someone else, not at this dinner, was commenting on the difference between the old Siegfried and Roy act in Las Vegas, which required Siegfried and Roy. Even though they were making 40-50 million dollars a year, they had a very large show, had around 400 employees, they needed to have Siegfried and Roy there for every single act. As opposed to the Blue Man Group, in which there are the “original Blue Men” who came up with the concept and then I don’t know how many touring groups of “performing Blue Men.” The original Blue Men don’t actually perform anymore, they’re basically running a very large blue man entertainment complex.
Many people in healthcare, certainly many physicians, are hands-on like Siegfried and Roy. They’re not hands-on in terms of coming up with the design elements and then pulling the strings or supervising over those who are actually performing.
Part of the problem - and there are many with that business model - is that the performers (physicians in this case) tend to be so focused on the performance that they’re not seeing many of the elements around themselves, elements that impact their business. As a result, they are often hit by surprise when, on another level of occurrence that’s not from what’s directly in front of their face, something happens.
Think about whether you and your practice are spending too much time almost viewing what’s going on around you through a screen that is showing what you think is reality, as opposed to removing that screen, taking time to sit back, and look at the bigger picture.
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| | Thursday - Podcast: For Sale - Slightly Used ASC |
| Listen to the podcast here, or just keep reading for the transcript
Sure, you can buy a new 2019 Bentley Continental GTC for around $300,000. But you can pick up a gently used 2016 model for around half the price.
But did you know that the same bargain can be had on a slightly used ambulatory surgery center?
Last month, two facilities owned 51% by Surgical Care Affiliates (SCA) the ASC behemoth owned by the even bigger healthcare behemoth UnitedHealth Group, Inc., became the equivalent of not simply a slightly used exotic car, but of a slightly used GMC Yukon.
Set up as a venture between majority-owner SCA and various physicians, Belleville Surgical Center, LTD, operated two ASCs, one the eponymously named Belleville Surgical Center and the other Physicians’ Surgical Center, both located in Belleville, Illinois.
From an Illinois state filing, many of the physicians who had previously referred their cases to the ASCs joined hospital affiliated medical groups. Their referrals to the ASCs dried up.
SCA, as the ASCs’ manager, sought a buyer for the facilities as ongoing operations, in other words, as operating businesses.
But operating businesses sell for more money than, well, the skeletons of closed businesses. No buyer stepped up and the facilities closed.
But just like the smart shopper for a slightly used Bentley, up stepped a smart shopper, Shakeel Ahmed, M.D., a gastroenterologist. Dr. Ahmed purchased Physicians’ Surgical Center’s operations, as well as Belleville Surgical Center’s land and building, for $50,000. Yes, just $50,000 – all of the zeros are accounted for.
Of course, there’s no way of knowing what equipment was included in the deal – much of it under SCA’s management may have been leased. But under almost any guess as to what’s going to be involved in bringing the facility back into operation, the deal was a tremendous bargain, perhaps up to 99% off.
I’m not saying that it’s every day that a bargain like this comes around. But there are more distressed sales and other creative opportunities around that one might think.
There are other lessons here, too.
Belleville’s state fling reveals that the physician investors didn’t, as individuals, have a significant amount of skin in the game, with none of them owning more than 5% of the deal. What exactly they lost when they gave up their independent practices and signed up with hospital employers is unknown. More skin in the game might have led to a different outcome.
Having a giant corporate partner in the deal didn’t help either. In fact, it might have made it more likely that the individual physicians would stop using ASC.
Just like each of the pennies on the dollar that Dr. Ahmed used to pick up the ASC, there are two sides to the ASC coin. Some facilities fail. But even when they do, they may be a tremendous opportunity for you.
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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 here.
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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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