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| Dear Friend,
On Monday, Memorial Day, we ran this short post:
We analogize business to war. Litigation to battle. Negotiation to struggle.
We tend to forget that our ability to engage in analogies while safely ensconced in our homes and offices is due in large part to those who gave their lives in real war, in real battle, in real struggle.
Let’s remember.
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| | | Business Life in the Time of Coronavirus Mini-Series
The coronavirus crisis caused a short term economic crisis for many medical groups. Our mini-series shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
[If you haven't already seen them, follow this link to watch our entire series.] |
| | Tuesday – Physician Extender Sentenced to Prison for Fraud – Success in Motion Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript:
I want to talk with you today about a story I saw in the news about a physician extender, a nurse practitioner to be exact, who’s been sentenced to 20 years in prison for his role in stealing the identities of six physicians and then using them to bill for surgeries that never took place.
In addition, the nurse practitioner, Trivikram Reddy, was ordered to repay the $52 million he collected through his fraud.
In essence, this is really an old story, a story of a sort that I’ve seen play out many ways in connection with healthcare practices and businesses throughout the years.
For example, it could play out within a facility or a medical group internally, with office staff in charge of handling the accounts payable creating phony entities with phony invoices, submitting them and getting real payments. I’ve seen some terrible outcomes in terms of that type of fraud.
I’ve seen it play out within surgery centers, with facilities run by unscrupulous sorts (we could call them mobsters) creating bills for surgeries, much like the nurse practitioner here did, for surgeries that never took place using, in essence, stolen anesthesiologist and surgeon provider numbers to fake surgeries.
If you followed the Forest Park debacle in Texas that went down over the past several years, there’s even the case of the anesthesiologist who billed for services that were supposedly performed while the anesthesiologist himself was under anesthesia.
So be very careful to protect how your provider number and identity are used. If you think that anything fishy is going on, investigate it and get counsel to contact the authorities.
I’ve seen these things blow up, and the downside for the innocent party is that they often get embroiled in what the prosecutors are certain was fraud committed by the individual who was really just another victim.
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| | How to Deploy the Secret Sauce of Opportunistic Strategy
Webinar On Demand
They say that COVID-19 has changed the world, creating the "new normal." Many of your colleagues and many hospital administrators are running scared.
Others, leaders like you, know that crisis means opportunity.
Let me provide you with the strategic tools and insights that you need in order to seize opportunities, whether they’re in the context of your current business relationships, the expansion of your business activities, or the creation of new ventures.
You will learn:
•Defense as a defective default: It’s necessary, but not sufficient.
•Exploiting weakness: Drop the guilt and identify opportunity.
•Flat line negotiation is fatal: Understand its myths and limitations.
•Negotiation reality: Learn to identify and deploy on multiple planes to affect the outcome.
•Maneuver: Harness the power of maneuver, both in overall strategy and in specific negotiation strategy.
Others see a crisis and freeze in fear. Learn how to see the opportunities and obtain the tools to increase your odds of obtaining them.
The price to attend is $479. The cost of not attending is astronomical. |
| | | Wednesday – Surgeon Gets Just Desserts for Healthcare Fraud – Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
What is your favorite dessert, something that goes well with barbecue?
Whether it’s pie or vanilla ice cream (or both!), it’s probably not 10 years in federal prison.
That is the just desert dished out to spine surgeon Mark Kuper, D.O. in late February 2021 for his role in a conspiracy to defraud Medicare, Medicaid, and Tricare.
Front and center in the story are Mark Kuper, D.O., and his wife (and errant barbecue pit-master) Melissa Kuper.
The Salad Days
Dr. Kuper, trained as an orthopedic surgeon, initially practiced in that medical specialty, but, apparently, as a result of medical malpractice lawsuits, gave up his surgical practice. Instead, in 2014, he began operating a pain management practice, the Texas Center for Orthopedic and Spinal Disorders (“TCOSD”), from two clinic locations. Mrs. Kuper served as TCOSD’s office manager.
In 2016, a TCOSD employee, Richard Brown, filed an original, sealed whistleblower complaint against Dr. Kuper, alleging a host of False Claims Act violations.
As a result, in spring and summer 2017, the U.S. Department of Health and Human Services and the Texas Attorney General’s Medicaid fraud unit issued subpoenas to Kuper and TCOSD seeking medical and billing records related to federally funded healthcare programs.
It is reported that, after receiving the subpoenas, Dr. Kuper paid his staff overtime to put the practice’s records into cardboard boxes which were then taken by Dr. and Mrs. Kuper to their approximately 7,800 sq. ft. home outside of Fort Worth.
Overcooked
On what was probably a breezy day in October 2017, Mrs. Kuper decided to barbecue some medical records in their home’s outdoor fireplace in a misguided (on multiple levels) attempt to destroy evidence. Apparently forgetting one of the basic rules of starting a fire, she left it unattended. Before long, their mansion was in flames. In no time at all, it burned to the ground.
But not all of the medical records did; firefighters found a recognizable pile of them in the fireplace.
At the end of May 2020, the U.S. Government intervened in the whistleblower suit brought by Mr. Brown. And, on June 17, 2020, both of the Kupers as well as a physical therapist associated with TCOSD practice, Travis Couey, were criminally indicted for conspiracy to commit health care fraud, for health care fraud itself, and for unlawful distribution of controlled substances.
Just Deserts
Three months after the indictment, Dr. Kuper pleaded guilty to one count of conspiracy to commit healthcare fraud. In late February 2021, he was sentenced to 10 years in federal prison.
In connection with his plea, Dr. Kuper admitted:
- That he fraudulently build insurance for services that were never rendered, including physical therapy and psychotherapy.
- That patients were required to attend bogus appointments in order to obtain prescriptions for Schedule II controlled substances.
- That he used a boilerplate template for physical therapy plans although he submitted claims stating that TCOSD developed individualized plans for each patient.
- That TCOSD billed for one-on-one therapy, even though patients met in groups with a trainer, not a physical therapist.
- That he gave his wife access to the secure device and passcode he used to sign controlled substance prescriptions, allowing her to improperly dispense pain medications on her own initiative, without his input.
- That although he billed insurers for professional 60-minute psychotherapy sessions, most patients actually spoke with unqualified professionals for just 15 to 20 minutes – often when he was out of the office.
- According to the Department of Justice’s press release, Dr. Kuper billed as though he’d provided more than 100 hours’ work in a single 24-hour day. From 2014 to 2017, he submitted more than $10 million in claims to Medicaid, Medicare, and TRICARE.
The DOJ also stated that Dr. Kuper tried to cover up evidence of the fraud by accessing hundreds of electronic patient records and altering the purported treatment notes to make them appear more comprehensive.
Melissa Kuper pleaded guilty in September 2020 and received an 18 month sentence. Travis Couey, the TCOSD physical therapist, pleaded guilty in September 2020 and received a 36 month sentence. |
| | | Listen to the podcast here, or just keep reading for the transcript.
Let’s talk about contingency fees. No, not contingency fees in the sense of a personal injury or a medical malpractice lawyer. And no, not contingency fees in the sense of the type of contingent and blended fee deals that I do on transactions with clients from time to time.
Instead, I want to talk about you being on a contingency fee.
I certainly know that my audience is comprised chiefly of physician leaders, as well as the owners of healthcare facilities who don’t consider themselves on contingency unless you do some workers’ compensation work — which is sometimes a form of contingency work.
But what I’m talking about is a contingency mindset.
How would you conduct yourself and your practice/business if you were compensated only for a successful outcome? For purposes of this mind experiment, this thinking tool, it doesn’t matter how you measure “success.” It could be a happy patient, it could be a successful treatment or successful procedure, it doesn’t matter. But if that were the case, that you were only paid upon “success,” how would you organize things and operate differently?
It seems simple. It seems like it is a game. But think about it, because the reality is that you are on that contingency basis. Referral sources could leave you and facilities can terminate your contract. Patients could walk for someone across the hall or across town.
So spend some time thinking about it: How would you reorder your business, your practice, and your relationships, if the only way that you got paid was based on a successful outcome?
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| | | Calibrate Your Compass
Read our exclusive RedPaper to guide you through this evolving situation.
The coronavirus crisis caused a short-term economic crisis for many medical groups. Our RedPaper shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
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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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