10/28/2015    Jeff Kittay, DPM

$83K Settlement Reached with VT Podiatrist over Medicaid Claims (J Kevin West, Esq.)

The particulars of this case are quite
reminiscent of one perpetrated by Medicare more
than a decade ago on DPMs in New England. Those
of us who saw patients in nursing homes(NH)
received a letter indicating that the code we had
been using for an initial examination in the NH
was NOT the one we should have been using, but
instead a different one that reimbursed at a
lower level.

My bill from Medicare was slightly more than $8K,
payable immediately, subject to offset of future
billings if not paid in 30 days. I called
Medicare for an explanation and was informed that
I was "one of the small fish, some of your
colleagues owe more than $150K," which reassured
me no end. I was also informed that this was an
anti-fraud investigation of all DPMs in New
England and that I should not take it personally.

There were two women working 40 hours/week
involved in this investigation. I spoke with
these investigators several times in the ensuing
weeks and was eventually told that rather than
have us pay the take backs all at once, which had
generated much protesting from the DPMs
concerned, Medicare in their kindness and wisdom
would reprocess all the claims involved, at the
lower reimbursement level, and that we would then
"only have to pay back the difference,' in my
case about $2,500. Since at the time I had a
spare $2,500 that I was going to throw away
anyway, I instead sent in to Medicare.

Further discussion with the two nice ladies at
Medicare revealed something more interesting. I
asked them, if after all their work, which had
been going on for many weeks, whether the
investigation was at least financially useful to
the government. One of them informed me that
collections were "running about 2 to 1." I said,
"well at least you're making money for all the
effort." "Oh no doctor" she said, "we get back
about $1 for each $2 we spend." I asked her to
repeat it as I found it difficult to believe I
had heard correctly, and she did so. I then
asked if it wouldn't have been cheaper to send
all of us letters warning us to not use the code
involved and that if we did so, we might face
fraud charges. She admitted that this was true,
but said "This is what our supervisor told us to
do."

I'm always glad to find examples of government
(my) money well spent.

Jeff Kittay, DPM, Boston, MA

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