10/28/2015    Michael M. Rosenblatt, DPM

CA Podiatrist Pleads Guilty to Healthcare Fraud (Steven J. Kaniadakis, DPM)

Steven J. Kaniadakis, DPM asked about "down-
coding" which some practitioners believe is a
"safety tactic" to avoid audits and Government
complaints. Deliberate under-coding is not a
reliable or safe tactic. The government knows
that some cases you see (should) require detailed
examinations and detailed chart notes. They
expect to see them; and they expect to see them
documented.

In order to be covered by Medicare a treatment
must be "medically necessary." There is a wide
variation by specialty that defines what medical
necessity actually is. Since DPMs still see a
large volume of nail fungous disorders, there is
a tendency to try to find ways to see Government
pay for that.

If a patient does not have attributes that
demonstrate medical necessity in these patients,
your trimming of nails and calluses are NOT
covered by the government. Under-coding them will
not demonstrate medical necessity.

Now is the time for the podiatry profession to
explain (and teach) patients that trimming of
nails and calluses is only covered by Medicare in
roughly 5% of cases. Because a neighboring DPM
got them "covered" does not mean that they
actually are. Patients will ask you why you
cannot get this treatment covered.

I recommend that you provide written explanation
of RFC. This can be written in multiple languages
which you can set up with Google Translate (for
free). You WILL lose patients. But the very
patients you lose will be the first to "rat you
out" when Government investigators knock on their
doors if you try to stretch the limits. It is
time for patients to pay for this themselves.
When every DPM works together, we can "re-train"
our patients.

Obama care is proving very expensive for
Government because of subsidies offered to low
income families. This puts more pressure on the
healthcare system to ferret out fraud and abuse.
Non-covered routine foot care is an exceptionally
easy place for Government to target.

There are multiple ways to earn a successful
living doing podiatry. You can attend seminars on
practice management and learn from DPMs who have
made it work. They are doing things that you are
not doing and they have skills that you don't
have. APMA also has an excellent coding data base
for DPMs. Membership has its advantages.

Michael M. Rosenblatt, DPM (Retired),
San Jose, CA

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