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And have solid proofYou need to be more specific about what he does
If you have documented proof of Medicare fraud, you can report him to CMS. Be sure that it's well documented, and truly fraud though.
If he's investigated and convicted, you stand to make a killing as a whistleblower and won't have to work again. If he's not convicted, you've ruined your career.
Actually, either way you've ruined your career. But at least in the first case, you'll make bank on it.
They are assuming word gets out and the OP is blacklisted by their medical community. One would hope that wouldn't happen but it's certainly not impossible.How would OP ruin his/her career if attending was not convicted?
Word will get out. The OP will be blackballed.How would OP ruin his/her career if attending was not convicted?
Do you have concrete proof they don’t want to give up the billing? If the population is as described, they may well be able to hide behind the opinion that such higher level of care was futile and unlikely to result in improved quality of life. There’s a very wide gulf (and a substantial burden of proof) between “bad care” and criminal fraud/abuse. What you’re describing doesn’t meet the CMS definition for fraud, and they’d likely be disinclined to go after someone who’s actually saving them money by avoiding costly and possibly futile care. You’d be significantly better off (if you are 100% certain of the motivation behind the behavior) making an anonymous complaint to your state’s medical board.Patient has a stroke, MI, trauma or something else that needs transfer to a tertiary facility that has stroke center, cath lab, trauma center. Attending doesn't want to give up the daily billing and refuses transfer.
For those of you who said to collect evidence or documented proof - how can I do this without violating HIPAA?
if there is daily billing for those pmts, the decision was made by the ED that the pt didn't meet the time frame for emergent cath, tPa, level 1 trauma...unless they are decompensating on the floor...and even then, if they don't have the ability to get the pt to the tertiary center in time (what's the closest facility and how long does it take to get there?), medically it may not make sense.Patient has a stroke, MI, trauma or something else that needs transfer to a tertiary facility that has stroke center, cath lab, trauma center. Attending doesn't want to give up the daily billing and refuses transfer.
Patient is not stable for discharge per some specialists, but patient's long term care facility is afraid of losing patient so attending discharges unstable patient anyway.
For those of you who said to collect evidence or documented proof - how can I do this without violating HIPAA?
I can't give away much information, but anyone who has suggestions, please PM me.
One of the attendings in my residency has a primary goal of maximizing his bottom line, regardless of patient care. I am pretty sure that if Insurance Panels, Medicare, State Licensing Board, and Specialty Board can obtain details of some of the things he has pulled off, they can hold him in violation or liable in multiple regards. The hospital turns a blind eye because he makes them money as well.
I've seen him do some pretty awful things to his patients, who are fittingly (for him) old, poor and demented without families.
How can a resident deal with this without jeopardizing our job?