Home Forums Discussions Problems "Are you an undercover patient?"

What is wrong if the initial intake for a new patient form asked:

"are you an undercover patient?"

The reason for asking this question is obvious.

Actually, it isn't obvious. Can you explain?

Huh? What? They work for the FBI? The CIA? The NID? The TRUST?

Well if he explains, it will blow their cover.
Don't do it!

Is it Indy?

Just joking around joseph.

Oh.

I think this relates to an article I read yesterday where "secret shoppers" will be used as pretend patients to rate us. I can't remember whether it was insurers or some government entity doing this.

Joseph, I think it's an appropriate question. There are people who present to Physicians offices to see if they are really doing what they say they do in an initial exam. This has happened to me. At the end of the visit, the guy identified himself as an investigator, but wouldn't tell me for whom. I told him I could charge his insurance company for a fraudulent patient visit and that he owed me cash for the visit. He paid, and I never heard anything from it again.

Try this:

http://www.perstrat.com/press

Indy10

I'm pretty sure I had one, years ago. Very scruffy, unbathed 30 year old demanding to be seen late Friday afternoon desperately needing narcotics for migraine. When told I needed to see previous records and would not just give him drugs he just said, "Oh, OK" and left meekly, without an argument. Around that time several docs got unpleasant visits from the DEA for prescribing to addicts. This guy was so laughably obvious that in hindsight I am quite sure he was a plant.

Having him pay for the visit in cash is a good response. You guys need to discourage this behavior. What is needed is undercover doctors. The patient goes in,and then the fake doctor sees if they answer followed the intial visit instructions, were rude, or refused to answer the doctors questions in a straightforward manner. "how long have you had this pain?" "Since forever doctor" . Oh, more than a year ? "Oh, not that long" "so, how long?" "Oh, for a long time doctor."

There was a radiologist in our community who was nabbed by the feds for billing for extra mammogram views without actually doing the extra x-rays. They used the testimony of several female undercover patients to convict him. Can you imagine how crazy these undercover patients are, that they would get radiated to nab a crooked doc?

It's Open Hunting Season on you guys, Boys and Girls....

This sounds like a "john" (not you Jon or Jon <smile>), asking a prostitute whether they are a "cop" before services are rendered.

Does the undercover patient legally have to answer truthfully? Probably not.

I think there are two separate issues here which have inadvertently become linked in peoples minds.

The examples given above are all pretty reprehensible attempts to trick us or trap us into revealing some sort of "bad behavior".

On the other hand, I think this thread is based on the article in the NYT which Joseph links above. To my mind, the topic of that article is VERY different. It describes an attempt by HHS to document the shortage of primary care providers by assessing the length of wait times until an appointment is available. It is simply a survey where people call the office and ask about getting an appointment. There is NO contact with the provider or rating of their services. Some docs (quoted in the article) have a problem with this. In my opinion, it just allows for more accurate data collection about a serious problem; one that it would be to our advantage to have documented and exposed (namely, the shortage of primary care providers). I don't see it as a threat.

Actually, i don't think think there is a shortage of primary care providers in the country--at least not in the urban areas. Shortages in rural areas are due to issues that go with it being a rural area.

There may be shortages for specific insurance plans, but again, that is due to speciifics about the plan (can you say "reimbursement"? how about "red tape?")

If all the medicaid patients cannot get appointments, but the commercial patients can, their is an issue with the medicaid plan, not a general shortage of pcps.

OK fellows wake up ! ! ! ........Believe it, it's true....its in the law books and it's on the record !

There are fake patients, and they do come in and they CAN change your life !

I have personal knowledge of a physician who "gave away care" ...ie charged them nothing, zero dollars, gave his own time and service to about 20 patients in a 12 month period to uninsured teachers, pastors, nurses and allied health professionals and was sued by a State goverment for ~ $ 6 million and his license.

What was the charge...?,... a two tiered billing system ! No charge for some and regular charge for the insured !

After nearly 2 years of depositions, a week of trial court, newspaper headlines that he was accused of insurance fraud, mail fraud, falsifying records,theft, and racketeering....the practice and physician destroyed and ruined by this time....

The jury verdict....? Guilty !!!!

It was appealed to the State apellate court, where it was overturned and reversed against the jury verdict! It was re-appealed by prosecutors to the State Supreme Court level and thankfully the Appellate court's decision was upheld.

These people wanted this bad...! They wanted to be able to pursue ANY doctor for having discrepency billing, in this case free services for WHATEVER personal physician basis.....this would have been a potential benchmark case and they knew it !

Trust me they are still out there...I was there , and I saw it first hand

This is the main reason we have opted out of Medicare and Medicaid. The same thing happened in this state, only fraud charges brought by Medicare against a physician for giving away services for free. They finally backed down after every MD in the state threatened to quit Medicare. Moral for me: don't take government money, don't sign contracts, don't promise your lowest charges to anyone.

Obama Administration Abandons "Mystery Shopper" Plan.

The New York Times (6/29, A15, Pear, Subscription Publication) reports, "The Obama administration said Tuesday that it had shelved plans for a survey in which 'mystery shoppers' posing as patients would call doctors' offices to see how difficult it was to get appointments." In a statement, HHS said, "We have determined that now is not the time to move forward with this research project." This decision comes on the heels of "criticism from doctors and politicians," and it "represents an abrupt turnabout," because just a few days ago, "officials at the health department and the White House staunchly defended the survey as a way to measure access to primary care, and insisted that it posed no threat to privacy." Nevertheless, HHS spokesman Christian J. Stenrud said, "Politics did not play a role in the decision."

Dr Miles--

What state is that? Can you give me a link? That must all be public record.

Thanks

Dr. Miles,

Tom beat me to it, but I would really like to see a link or reference for that, too.

I googled it. There were about half a dozen states they were going to do it in. Just google "undercover patient"

In this time of fiscal shortage, Obama has way to many pet projects that should be shelved.

I think a project showing it takes two weeks to get into a FP doctor would be a good thing for us.

I give away free care and discounted care all the time. Most of the time with the uninsured, it is a win-win situation. And, no, I am not worried about posting it here.

I agree with Bert. I think the idea that we need to fear providing free care is a bit of an urban myth.

Wayne:
Tom and I were not questioning the existence of "undercover patients". Dr. Miles talked about a case of a doc who "gave away care to 20 patients" and was sued for $6 million. We were asking for a link to articles about that case (which was "in the headlines").

This is what I don't understand. Don't want to say too much since above sounds like it would be called antitrust or whatever, but not two doctors have threatened that here. I don't understand how that would not work as far as negotiating. But, it seems that the board would have a lot of leverage with suspending licenses while there would be mass havoc on the infrastructure of patient care for weeks.

The answer is it doesn't matter. If there on a "mission" they are excused from liability and lawful proceedings. They are doing "legal investigations" from a higher authority.

see my answer to joseph 2

They work for insurers that are looking for ways to target physicians for charges they are trying to review for inappropriatness or questionable charges they would like to not reimburse.

There's not a cover up .....in this issue, but I assure you, you better think about this issue when you give away care which most of us do ! I'm telling you this is no BS or a story, it is fact and it is in the legal system court records and I have seen it.It is in the U.S. legal system records documentation and it is public record.