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04/25/2013    Michael J. Schneider, DPM

Podiatry’s Secret Problem (Steven Moskowitz, DPM)

Dr. Moskowitz’s post was the second post in a few
weeks by a member of our profession intimating
that there are a significant number of our
colleagues who are intentionally
scamming/stealing from insurance companies by
overbilling and billing for procedures or
services not needed.

He based his statement on the fact that Medicare
was billed $120 for his mother’s visit with a
podiatrist at her assisted living residence and
previous nail treatment by other podiatrists. My
question would be who ordered the visit? Was it
his mother’s PCP? Was it a relative? Was it the
facility? Why was she seeing a podiatrist before
moving to assisted living?

There is coverage for routine foot-care in
certain instances. No matter who ordered the
visit the podiatrist was entitled to bill for the
visit and possibly the care. In addition Dr.
Moskowitz states that the bill was $120. I would
like to know what the podiatrist was actually
paid. From my experience treating SNF and nursing
home patients I would venture to say it was
considerably less.

Since most, if not all, of our reimbursements are
based on contracts, it does not matter what is
billed. I recently had an MRI. My insurer was
billed $2092.00 and the provider was paid a
contracted amount of $631.69. Ours is a noble
profession as are other medical disciplines.

There are those who would dishonor themselves and
their profession but I believe that they are few
and far between. Personally, I do not know nor
have I ever known a colleague who intentionally
billed for services not performed. The only
instance where I see that is in the reporting
done in this forum where someone was caught.

Michael J. Schneider, DPM, Denver, CO,

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