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RE: EMR and Healthcare Fraud

From: Robert Kornfeld, DPM

If you didn't believe me before, perhaps after you read this article, you'll believe me now. This is what the EMR push is all about.

In my world, I discuss the diagnosis and recommended treatment with my patients. We collaborate on a treatment protocol. They pay me. I do not have to "upcode", "downcode", "invent a diagnosis", or "create add-on procedure codes" to get paid. If an insurance company rejects a claim on behalf of my patient, it's not my problem. If they audit claims and want money back, they will have to get it from the beneficiary (the one who pays their premium), not me. Fraud exists for one reason and one reason only - third-party payers.

Many of the physicians in my area are selling their practices to hospitals (because the stress of making a living has become too great), or they are converting to concierge medicine. My own internist just went concierge. I am sticking with fee-for-service because it works for me and my patients.

Robert Kornfeld, DPM, Manhasset, NY,

Other messages in this thread:



RE: Wart Treatments (Theresa M. Hughes, DPM)

From: Kevin A. Kirby, DPM

I have been using Falknor's needling method both for solitary and mosaic verrucae quite successfully now for the past 20 years.  The late Gordon W. Falknor, DPM, first described this "needling method" for verrucae plantaris treatment in "Falknor GW: Needling-a new technique in verruca therapy: a case report."  JAPA, 59:51-52, 1969.


Falknor originally described his needling method to offer the following advantages:


1. A minimum of time is required to perform this technique.

2. A minimum of material (anesthetic, syringe, dressing) is employed.

3. There is a minimum of post-operative pain.

4. A minimum of bandaging and dressing is needed.

5. A minimum of post-operative calls are required.

6. No ulceration, infection or scarring results.

7. The patient may continue to bathe as usual.

8. There are no restrictions on work or athletic activities.

9. There is a low rate of recurrence.


These have also been my clinical observations in the numerous times I have performed his technique on my own patients over the past two decades.


A more recent study of 45 patients was just published a few months ago in the Journal of Clinical Medicine that showed a 69% resolution of verrucae following needling treatment (Longhurst B, Bristow I:  The treatment of verrucae pedis using Falknor's needling method: A review of 46 cases.  J. Clin. Med. 2013, 2, 13-21: doi:10.3390/jcm2020013).


Kevin A. Kirby, DPM, Sacramento, CA,



RE: Diagnostic Ultrasound (David E. Gurvis, DPM)

From: Bryan Markinson, DPM

Drs. Gurvis and Foreman take my research idea and interpret that my intention is to prove that ultrasound use is fraudulent or somehow unethical, or even unnecessary. Nothing could be further from the truth. However, I will never be convinced that the majority of current users are adequately trained in musculoskeletal ultrasound in proportion to its frequency of use.

Bryan C. Markinson, DPM, NY, NY,



RE: SudoScan (Howard Dinowitz, DPM)

From: Robert Bijak, DPM

Of course, this is an INDIRECT inference; that should be obvious. The only direct test would be nerve conduction studies, and they should be performed by an MD neurologist. Forget the insurance reimbursement and do the right thing.   

Robert Bijak, DPM, Clarence center, NY



RE: SudoScan (Howard Dinowitz, DPM)

From: Stephen Barrett, DPM, MBA

Peripheral neuropathy (PN) has many etiologies, and can have great variance from patient to patient. As we all know, there are two components to PN—sensorimotor and autonomic. There are numerous ways to evaluate the sensorimotor status of patients with PN, including, but not limited to NCV/EMG, clinical evaluation, epidermal nerve fiber density biopsy, high resolution diagnostic ultrasound for entrapment, neurosensory testing with the PSSD (pressure-specified sensory device), vibrometry, and physical evaluation, to mention a few.

However, autonomic dysfunction of the peripheral nervous system has, up until this point, relied solely on observation of xerotic skin, and the failure to sweat. The SudoScan device appears to be the first simple-to-use, reliable, reproducible, and objective measurement of...

Editor's note: Dr. Barrett's extended-length letter appears here.



RE: Inexpensive Cast Cutter (Joseph S Borreggine, DPM)

From: Eric Trattner, DPM

This cast cutter is very durable and works particularly well, even during power outages!

Inexpensive Cast Cutter

Eric Trattner, DPM. Fairview Park, OH,



RE: Reliable Billing Company

From: Ilona Barlam, DPM

I highly recommend Billing 101, a company based out of Washington state. They do the best follow-up on denied claims, and consult on proper billing and coding.  They are also operated by a DPM group. We went through 4 different billing companies and never had it that easy.

Ilona Barlam, DPM, Redmond, WA,



RE: Reliable Medical Billing Company

From: Bessaliea Griffin, DPM


I am using American Healthcare Billing Services in Dallas, TX. They do an excellent job. One of the great things about the company is that it is operated by a licensed podiatrist. I am a new solo practitioner; therefore their knowledge and experience have been extremely helpful with proper billing and coding. 


Bessaliea Griffin, DPM, Smithfield, NC,



RE: Reliable Medical Billing Company

From: Steven Gershman, DPM

I have used MedBill Resources for about 15 years. They do all types of medical billing but are especially good with podiatry, including DME. They handle every aspect of the receivables and any insurance company denials. Outsourcing billing to them was my best decision. Contact Pat Roy at 207 786 8816.

Steven Gershman, DPM, Auburn, ME,



RE: Reliable Medical Billing Company

From: David Mullens, DPM

I have used Caroline Kats in San Francisco for all of our billing for 5+ years. She is nothing less than sensational. When I told my wife/office manager I wanted to hire Caroline for our four-doctor practice, my wife was really against hiring an outside biller. Within three months, my wife thought Caroline was the best thing ever to happen to the practice. 

Caroline is smart, hard-working, knowledgeable, and experienced. We scanned and emailed all of our routing slips (superbills) and checks (with attached EOBs) every day. It was painless and completely effective. In addition, Caroline was expert at handling patients calling with payment issues. Her email address is Call her. You won’t be sorry.


David Mullens, DPM, Palo Alto, CA,



RE: The Disruptive Physician (Steven J. Kaniadakis, DPM)

From: Dan Chaskin, DPM

Disruptive physician is a term whereby physicians may be more verbal in expressing their opinions or more anxious to initiate needed changes in hospitals' bylaws. Some of these attributes may indeed be desirable if hospitals make decisions that do not benefit a patient's right to choose the physician who treats them.

For example, if a hospital has a bylaw requirement that accepts one board and not another for certification or hospital privileges, a complaining doctor may be labeled as disruptive. Have any physicians ever had arguments with administration? Who determines what is disruptive behavior, the administration in charge or an independent panel of physicians?

Dan Chaskin, DPM, Ridgewood, NY,



RE: Time for EBM Study on Custom Orthotics (Carl Solomon, DPM)

From: Richard A. Simmons, DPM


Dr. Solomon states that he wants our experts to compare “custom” orthotics to OTC inserts to see if there is a statistical difference between the two. In my opinion, the study has to have thousands of patients who are being treated by exacting standards, such as the position the foot is held during casting or impression, what are the x-ray findings, what are the clinical findings, mycotic/gryphotic hallux nails, etc.

Essentially, there should be one or two companies who are manufacturing these devices and they should have a standard level of quality control. Once that gold standard is achieved, then we can approach insurance companies with empirical information; however, I doubt we are moving into an area of increased insurance reimbursement for anything.

Richard A. Simmons, DPM, Rockledge, FL



RE: Reference Source for Surgical Instuments

From: Jack Ressler, DPM

I recently spoke to Blair Engelken from Engelken International ( and found him to be an excellent resource for surgical instruments. Blair's knowledge of surgical instruments is related to spending many years of learning this specialty while in Europe. His wealth of information includes manufacturing and product selection for one's specific needs. Obviously, the right choice of instrumentation is critical in the ease and success of any procedure.

Disclosure: I do not have any financial ties or receive any compensation from Engelken International.

Jack Ressler, DPM, Tamarac, FL,



RE: Billing Service Fees (Name Withheld (NY))

From: Timothy James Henne, DPM, Salvatore J. Galluzzo, DPM

Keep track of all non-insurance stuff in non-billing software. Scan it, save it, or import it into another chart. You are being RIPPED OFF. Do not rely on the billing service to not charge you for those issues. It is also easier to keep track of sales and inventory.

Timothy James Henne, DPM, Clermont, FL,

6.5% is a great rate if your company is professional. On items sold in YOUR office by YOUR staff to YOUR patients, NO it is not the standard. You should count it as income - not to get in trouble with the IRS, but your billing service should not benefit from work they didn't perform.

Salvatore J. Galluzzo, DPM, Clifton Park, NY,



RE: (Andy Dale, DPM)

From: Philbert Kuo, DPM

If you are considering, then also take a look at I think it's about 5% less expensive. Do a Google search on mobile credit card readers and read the reviews to get a better understanding of what is available.

Philbert Kuo, DPM, Chesapeake, VA,



RE: Staff Makes it Difficult to Get Appointments (Name Withheld)

From: Gary Docks, DPM

Your ghost caller with symptoms of diabetes and an ingrown toenail was not given a same-day appointment after you specifically told your office manager and receptionist to do so, can only mean one thing. Who the hell is running this practice? The only acceptable response would be how long have you been working here NOT INCLUDING TOMORROW? You need to take control of this situation.

I faced that situation many years ago and nipped it in the bud quickly. The question is, did you put a limit on how many patients you wanted to see in a day or perhaps after watching you, THEY decided for you how many patients would be seen. Do you spend a lot of time with each patient? Take control of your practice or don't complain. After your ghost caller verified your suspicions, unless they had a good explanation for their actions, I would make sure that the door to your office hit them in the ass on their way out. Pull the plug and take some management classes to prevent this from happening again.

Gary Docks, DPM, Beverly Hills, MI,



Re: Staff Makes it Difficult to Get Appointments (Name Withheld)

From: Robert Scott Steinberg, DPM, William Deutsch, DPM

Dear Name Withheld, You have seen your employees' true colors. Will you ever be able to trust them again?

Robert Scott Steinberg, DPM, Schaumburg, IL,

Unfortunately, your staff is sabotaging your practice to ensure their workload is light or not overly burdensome, and to ensure their workday ends on THEIR schedule. The tail is wagging the dog. This is symptomatic of a dysfunctional office. New patients should receive priority scheduling, especially if they're in distress. That shouldn't have to be included in a manual; that's common sense.

I don't know how long your staff has been working for you, but they're not 'on your side.' With the job market as it is today, replacing your contrarian front office worker should be easy. Do you really think that an office meeting will change anything? 

William Deutsch, DPM, Valley Stream, NY,



RE: Smart Patient With Smart Phone

From: Bret Ribotsky, DPM

I recently heard a telling story from a fellow DPM. He had a patient with a ligamentous injury and offered the patient conservative care of a soft cast for edema and a BK-walking boot to reduce pressure and load from ambulation. This patient’s insurance does not cover the cost of the BK-Boot. So the doctor told the patient his fee for the boot. The patient said okay and the doctor started to put on the soft cast. 

The podiatrist left the room to retrieve the boot from his supply closet, and upon his return, the patient told him that he did not need the boot, as he just purchased it on the Internet from his smart phone for about half the price of what the doctor was charging. It will be delivered tomorrow. This is interesting food for thought about the different profit centers we all have in our offices. Times are changing.

Bret Ribotsky, DPM, Boca Raton, FL,



RE: The Podiatric Residency Crisis

From: Leslie Levine, DPM


I've heard the old adage that there is no such thing as bad press. However, after reading the first two posts in the May 1st edition of PM News, if I were an outsider looking in, I'd be hard-pressed to understand the need for a 3-year surgical residency to warn the public about the perils of nail salons and improperly fitting sneakers.
I'm sure the flip-flop and high heel warnings will begin to appear soon.

Lo and behold, what appeared in the May 4th edition... a reprint of an article quoting none other than the distinguished president of the APMA warning of the dangers of flip-flops.

Leslie Levine, DPM, Orangeburg, NY,



RE: Purchasing a Digital X-Ray System (Laura R Lefkowitz, DPM)

From: Harvey Danciger, DPM

I had an X-Cel x-ray unit for over 10 years, and went to a digital x-ray system about 2 years ago. It was retrofitted to the X-Cel base and integrates into my EHR. The quality is very good and the support is excellent. In the long run, it will save you money over processing films. The company was FOZ Networks. Anytime I had a question or needed to know how to do something, I received an immediate response.


Harvey Danciger, DPM,  Palm Desert, CA,



RE: Replacement for Fabco (Paul Taylor, DPM)

From: Brian Kiel, DPM

To replace Fabco, order Co-Wrap self-adherent bandages. We order the one inch rolls. It is supplied by Hartmann-Conco. It is actually better than Fabco because it is more flexible and easier to use. We order it from North Coast Medical 800/821-9319.

Brian Kiel, DPM, Memphis, TN,



RE: Podiatry's Secret Problem (Steven Moskowitz, DPM)

From: Don R Blum, DPM, JD

With all the comments and observations regarding DPMs who do not follow the rules as to routine foot care and exclusions, especially when we identify this related to a parent and/or family member, how many DPMs have then contacted the appropriate license board or insurer and complained?

Don R Blum, DPM, JD, Dallas, TX,



RE: Podiatry's Secret Problem (Steven Moskowitz, DPM)

From: Lynn Homisak, PRT

I too would like to say "BRAVO!" to Dr. Moskowitz for speaking up! I have also seen this kind of manipulation going on in way too many offices...ever since the rules came out from Medicare about specific nail care coding (way back when.) Sadly, there are still offices that continue to work the system by manipulating codes and documentation in order to get paid and/or retain patients. It makes it bad for those who make the effort to code properly.

The doctor I worked for in NJ called 'em like he saw 'em, and like Dr. Moskowitz did not submit claims for non-covered nail services. Patients were informed what was and wasn't covered, signed an ABN, and paid cash. Period. As a result, we may have lost some patients to DPMs down the street who we were told submitted (erroneous/fraudulent) claims for them, but we never had problems sleeping at night! It's always better to do the right thing.

Lynn Homisak, PRT, Federal Way, WA,



RE: Podiatry's Secret Problem

From: Steven Moskowitz, DPM

Podiatry has a secret problem that needs to be exposed.

My 90 year old mother-in-law lives in Hallandale, Florida. She has been very healthy, never even taking any medications at her age. She recently started to show signs of senile dementia, so we decided she would do well in an assisting living facility. Four days after moving in, a podiatrist showed up to cut her toenails and billed Medicare $120. I want to make it clear that besides mild dementia, she has no health problems or toenail problems.

I recently retired from practice and had been too busy to watch her medical billings. Looking back over the past 10 years and probably longer, I now see that a series of different podiatrists have been cutting her nails as often as Medicare will pay for the service, even though she is not eligible for nail care.

These podiatrists are crooks, ripping off Medicare to the tune of millions of dollars. Our profession needs to police our own or the government will do it for us. The only thing we will be reading in PM News is which podiatrist got arrested today for fraud. Without trying to sound that I am without sin, I can honestly say that I never knowingly billed for a service I did not perform or that was not medically necessary. How many of our fellow podiatrists can say the same?

Steven Moskowitz, DPM (Retired), Houston, TX,



RE: gSource Instruments (Jack Ressler, DPM)

From: Ronald F. Iannacone, DPM

gSource instruments are great quality instruments at a very reasonable price. I started buying from them last year and have not had a problem with their instruments at all. Their staff is also very friendly and willing to accommodate you. 

Ronald F. Iannacone, DPM, Northport, NY,



RE: gSource Instruments (Jack Ressler, DPM)

From: David S. Wander, DPM

Our practice now orders exclusively gSource instruments for the high quality, reliability, and customer service. We have used a variety of their instruments, including surgical and palliative instruments, and all items have held up well to significant use and sterilization.  

gSource has our highest recommendation.

Disclosure: Our practice has no financial interest in gSource.

David S. Wander, DPM, Philadelphia, PA,

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