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Friday, July 01, 2011


Thanks for the hat tip/link Dr. X! and even more psychiatry news in the Childhood Bipolar world...Biederman,Wilens and Spencer investigated by Grassley for non disclosing of pharma income, have been sanctioned by Mass General!!

Dr. X, I can almost guaranty the backstory makes a not-quite-exactly fitting match with the Justice Dept press release, from my experience defending folks involved in physical medicine fraud cases.

One weird aspect of all this: The businesses who do billing processing for Medicare, Medicaid, etc. are paid a percentage of the billings they process, which means the incentive is to not stop excessive billings. In the cases I defended, the witnesses rationalizing what the Government and its contractors did called it a "trust" system-- the cash drawers are open, and people just take what they think they earned, I guess. The contractors had policies in place that prohibited them from telling a contractor that billings were suspicious. In one case I worked on, the contractor figured out everything they thought was wrong when the billings were less than $200K. They didn't tell the doctor or business "We think you're committing fraud," even when the doctor started inquiring and asking about the rules-- the contractor operating under the rubric "we're not supposed to tip them off to a fraud investigation. So they let the billings run to $6M before they answered, at which point the doctor shut the business down.

This is interesting. Fraud has always intrigued me and I'm amazed that people continue to pursue it as a means of financial gain. Recently, my health insurer has tried to convince me that I have some sort of supplemental health insurance---that "their records show" this to be true. I have no idea how their records came to this conclusion, inasmuch as a)I have no such supplemental insurance and b)I have never told them that I have such.

I sent their form back to them today, affirming the above. But I wonder what they may try to cook up next? I have not tried to defraud anyone. Have they, and if so, whom?

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