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question re: MTSOs who offshore - .

Posted: Nov 03, 2014

Why do they hire US transcriptionists and offshore transcriptionists? Why not just hire offshore if it is cheaper for them? Is it just that they want the US workers to do the harder work?

I think.... - Tran1

[ In Reply To ..]
they start out with US employees so the providers will see the good quality of their work for a few months or so and then they casually slip it to offshore workers hoping no one will notice. I've seen some of the work done in India and I can't believe providers put up with it. I mean 3 or 4 blanks for dictators that couldn't speak English more clearly than they already do, what we would consider easy dictators. It's pretty obvious the only goal of Nuance as far as transcription is for the economy of the people of India. They have no interest in us except to use us.

I Agree - see msg

[ In Reply To ..]
I agree with the poster--but want to add to it.

By keeping US MTs, they now have 24-hour a day coverage--when the Indians are sleeping, we're wide awake. Think of it as this--time difference in India (depending on exactly where) is at least 8-10 hours ahead of our time. So, say N or M pushes us to work 3 p to 11 p, because that's actually when the Indians are sound asleep.

We are also covering their holidays.

This is how I believe some MTSOs get away with - offshoring when it is prohibited

[ In Reply To ..]
A portion of the contracts an MTSO has may prohibit offshoring of the transcription. I believe by maintaining a small percentage of MTs in the US, they can claim that any and all offshore-prohibited transcription is being done here, even if it is being done overseas.

Example: An MTSO has 26 clients A through Z. All contracts for clients A through M prohibit offshoring. Work for clients N through Z may be offshored. The MTSO's transcription workload for all clients (A through Z) requires a total of 1000 transcriptionists. The workload for clients A through M requires a total of 500 transcriptionists. Say the workload for each client A through M is equally distributed so each client requires about 39 transcriptionists. So the MTSO should have a total of 500 US transcriptionists, right? But they don't.

I believe what they do is hire only 39 US transcriptionists. Most of the offshore-prohibited transcription is actually done by offshore MTs, costing the MTSO a lot less money. If and when the MTSO is questioned about where the offshore-prohibited transcription is being done, they can claim it's being done here in the US and their proof is that they actually employ enough US MTs to handle the work for that client. The problem is that they're claiming the same 39 US MTs are doing the work for all clients A through M, even though this is impossible. It's just a way for them to provide documented "proof" that they're not offshoring. The only way to catch them would be to do a detailed audit/investigation to find out exactly WHICH of the MTSO's MTs are actually working on what contract.

The reason I think this may be happening is because a few years ago, I discovered an MTSO in my state that I believe is illegally offshoring transcription. When generally questioned by state authorities, the responses were vague and in no way proved the MTSO was not offshoring. In fact, every piece of evidence available by googling this MTSO and its history strongly supports the notion that they are offshoring. The only thing so far that has suggested they are not offshoring is the owner's claim that he is complying. Two years after my initial complaint and two investigations later, a new audit is being conducted by a different state agency.

Illegally offshoring? - Details please.

[ In Reply To ..]
I'm very intrigued by your comment that you believed they were "illegally" offshoring.

Are there states that outlaw offshoring? Federally it seems to be skirting many laws, but doesn't seem to be downright illegal.

Or are you referring to an individual client contracting for on-shore work only and it was being done offshore, thereby "illegally" breaking the contract.

I really think if the majority of American's knew that their healthcare documents were being sent overseas, regardless of where, but outside the borders of our country, where we were so vigilant to create these HIPAA laws, they would freak out!

Illegal offshoring - sm

[ In Reply To ..]
In my state, it is illegal to offshore services on any state contract unless the contractor can demonstrate that the services cannot be performed within the US. This was the situation I was speaking about. The MTSO in question has a contract to perform medical transcription services for state psychiatric hospitals.

As you mention, there are situations in which the MTSO's contract with its client prohibits offshoring. From what I've read over the years on this board, I believe many MTSOs violate that term of their contracts. These violations may go undetected forever. There was at least one incident of such a violation (it is my understanding that the [EDITED] 2nd act of subcontracting in this case was prohibited) that came to light in a very interesting way. You can read about it in an article published in the San Francisco Chronicle in March 2004. After you read it, ask yourself if this violation would have ever been discovered had it not been for the actions of the Pakistani MT.

Illegally offshoring - Grandy

[ In Reply To ..]
I also believe that if the majority of Americans knew that their tax dollars funding VA Hospital were being used to enhance the lives of foreigners, they would "freak out. Personally, this is NOT what I want my tax dollars being used for. Alpha's American workers first experienced a cut in pay that was inconsistent with their contracts, then many of them lost their jobs completely. Therefore, the U.S. Government is deliberately unemploying American workers to enhance the earnings of foreigners.

This is how - Grandy

[ In Reply To ..]
This is exactly what IMedX is doing. They are using Alpha as a "front" for their VA work in order to get the contracts, and claim that no government work is going offshore, however, I don't believe that, because after IMedX took over, Alpha started terminating transcriptionists who used to have plenty of VA work to do, then got to the point where they were making only a couple hundred dollars in two weeks, and were being told by the "American" overseeing Alpha that they should stay on for extended periods of time and just keep hitting "refresh" to get work.

I have talked with someone (head of HIM) at one of the VA Hospitals, and she admitted that they were well aware that Alpha's parent company was IMedX, and that IMedX is an Indian company, but she stated that as long as they have an American company providing a "front" for them, it meets government requirements.

Therefore, American tax dollars, used to fund VA Hospitals, is being used to provide income for an Indian company.

I would challenge that VA HIM policy by reporting it - to the DOL

[ In Reply To ..]
Maybe the VA is okay with doing that, but the Department of Labor is not. I don't know if someone who does not currently work for Alpha/IMedX can file a complaint about this with the DOL, but SOMEONE needs to. Whoever works on that VA transcription has to have employee status and has to be paid the hourly wage determination rate.

When my MTSO (we have some VA contracts) was audited by the DOL, we were notified by management that we might be individually interviewed by the DOL. I don't know how many MTs were interviewed or what they were asked, but after they completed the audit, the DOL made my MTSO issue back-pay, change everyone's status to employee, and begin to pay everyone the hourly WDR.

You would think with all the controversy at the VA in the past year that they would be exercising better discretion in their operations across the board. The VA is not above the law, but they will obviously continue to conspire with these shady MTSOs as long as no one calls them out.

In this case, the 2 issues of offshoring and employee status go hand in hand. The former issue is one addressed in VHA directive 2008-042, and the latter issue is addressed in the McNamara-O'Hara Service Contract Act.

Can someone with knowledge of the particulars (which VA medical centers, etc) PLEASE blow the whistle on Alpha/IMedX and the VA by filing a complaint with the DOL?!?! Just pick up the phone and start talking. At this point, we cannot do much about legal offshoring, but we CAN do something if someone is actually breaking the law.

This is how - Grandy

[ In Reply To ..]
By the way, congratulations for being one of the few transcriptionists willing to stop whining and really fight these issues.

I am doing the same thing right now regarding the VA contracts. Head of HIM at the VA hospital I contacted stated that there were a lot of transcription companies that went after these contracts, but U.S. government went for the foreigners and the traitors assisting them.

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