A community of 30,000 US Transcriptionist serving Medical Transcription Industry

There was a story on the news last night - featuring a coder in San Diego - sm

Posted: Oct 17, 2011

She worked as a coder at a hospital that was bought/taken over by some new HMO (don't remember the name of it), and during staff meetings, they were telling the coders to replace one symptom description, such as "dizziness/fainting" with a more generalized neurological condition, because that condition caused the insurance companies to pay the hospital more. The condition they wanted her to put was something rarely seen, one doctor said he saw 2 cases in 13 years. Suddenly the hospital had a huge spike in "cases" in one year. The same was true for other conditions that the patients didn't really have, yet the coders were being asked to put into the record. She blew the whistle on them, and now they're being investigated.

PS: Correction, she worked for a coding company - FOR that hospital, not at the hosp.

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.

There was a doctor locally in our area who went to prison - for upcoding I think they call it

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Last I heard the doctor was still in prison and had to pay a huge fine. I hope they get some of the people who are involved in this fraud and abuse of the healthcare system.

Yes, I think it was the Feds who are investigating, - because it also happend at other - sm

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hospitals under this same HMO. The owner of the coding company said he no longer does business with that group, and said it was costing the taxpayers because it was mostly Medicare cases this was happening to.

It all just proves that what our entire country, from CEOs to insurance companies to hospitals, lawmakers, etc., needs is a major infusion of good old-fashioned HONESTY.

I remember a nurse who used to make false insurance claims - see message

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She was an OB/GYN nurse. She would drop by the patient's room and just wave at them or maybe even come in and ask how they were doing, then she billed for services, when she had provided none. I remember hearing her explain to someone that she gets more money by doing that.

I thought nurses were paid a flat hourly rate, not - on a "production" basis for pt. care. nm

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C

Not in this case. - nm

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nm

I sure don't want some production-pay nurse giving - me meds or stabbing my arm looking for a vein! nm

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Production pay INVITES ERRORS.

I don't either. - nm

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nm

Was this a nurse practitioner, not a "nurse"? - sm

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This wasn't a "nurse" in the LPN or RN sense. In most cases, they cannot bill for their services and are not licensed independent practitioners. They work in hospitals for hospitals, but do not drop by to see patients and then bill for it.

You may have been thinking about a nurse practitioner of some sort. They can bill for hospital visits.

What she did was unethical and illegal. It is illegal to bill for services unless you provided the services, and there are no billable services that consist of what you described.

That situation can and should be reported to the hospital, to the physician who employs her, to the insurer, and to the state licensing board.

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