Dr. Sievers' RHHC Medical Practice - Operations & Website

[DexterMorgan]

I brought back our original posts in an attempt to come to a conclusion.

Does Mark have hard copies available for the patients to sign for? Or is it possible for this to happen electronically?

He doesn't have the actual papers until he prints them out from the computer. Also he is not suppose to give them to the patient electronically. They will physically have to come in and show id and sign the records release form.

Now if ssi or ssd requested the records on your behalf to be sent to their office directly. Then he may be able to send it to those government entities electronically. But I'm not 100% sure on that part. So i hope this helps. Thanks.

 

[Tricia]

http://www.websleuths.com/forums/showthread.php?65798-Etiquette-amp-Information

Websleuths (WS) Etiquette & Information
VICTIM FRIENDLY

The "victim friendly" rule extends to the family members of victims and suspects.
Sleuthing family members, friends, and others who have not been designated as suspects is not allowed.
Don't make random accusations, suggest their involvement, nor bash and attack them.

SeesSeas, I know my own rules. Please stop. If you didn't get my point then I don't know what else to say to you.

Please go back and read my post to see WHY Mark is discussed here.

You are disrupting this thread.

Last time.

 

[Riversinthedesert]

http://www.websleuths.com/forums/showthread.php?65798-Etiquette-amp-Information

Websleuths (WS) Etiquette & Information
VICTIM FRIENDLY

The "victim friendly" rule extends to the family members of victims and suspects.
Sleuthing family members, friends, and others who have not been designated as suspects is not allowed.
Don't make random accusations, suggest their involvement, nor bash and attack them.

I would say that MSM stating that MS is "within the envelope of suspicion" is very close to designating MS as a POI. I think the mods have done a stellar job of keeping things within the bounds of reason and the facts of the case.

 

[DexterMorgan]

http://www.websleuths.com/forums/showthread.php?65798-Etiquette-amp-Information

Websleuths (WS) Etiquette & Information
VICTIM FRIENDLY

The "victim friendly" rule extends to the family members of victims and suspects.
Sleuthing family members, friends, and others who have not been designated as suspects is not allowed.
Don't make random accusations, suggest their involvement, nor bash and attack them.

If you don't want to go on a vacation. Then maybe you shouldn't keep filling out the vacation time-off request.

The owner told you what it is and how it will be. So that is the way it gone go. Lol. Trust me. Other crime forums will have you begging to come back.

So leave it be. Jmo.

 

[human]

This is plausible if they billed insurance and Medicare directly, it's a fairly common scheme with Medicare in fact, but since they didn't bill and the patients had to submit I don't see it working. The prescriptions don't make sense either IMO because the suppliers don't fill right to the dr office, the patient still has to go to a pharmacy. I mean I'm sure there may be other ways to commit fraud but I'm not sue what they'd be

Could the IT genius make up the clients and bill Medicare with the fake clients? How does a medical practice get working with Medicare?

Every time I go to the doctor, I get a printout from Medicare so he could not use real people unless he made some kind of fake address for the info . But how many fake addresses can you make?

 

[Deleted member 39678]

He doesn't have the actual papers until he prints them out from the computer. Also he is not suppose to give them to the patient electronically. They will physically have to come in and show id and sign the records release form.

Now if ssi or ssd requested the records on your behalf to be sent to their office directly. Then he may be able to send it to those government entities electronically. But I'm not 100% sure on that part. So i hope this helps. Thanks.

Thanks for your reply.

Anybody can find a file in a computer and print pages from it. It's not very hard to do.

JMO

 

[Riversinthedesert]

Could the IT genius make up the clients and bill Medicare with the fake clients? How does a medical practice get working with Medicare?

Every time I go to the doctor, I get a printout from Medicare so he could not use real people unless he made some kind of fake address for the info . But how many fake addresses can you make?

Thanks goodness human...back on topic here.

 

[beach]

Also from TOS, Rules & Etiquette

BAITING, TROLLING, INCITING CONFLICT
A member who visits WS only to incite "conflict" will be designated a "troll", and find his/her account temporarily or permanently suspended.

WS maintains zero tolerance for members who create posts intended to antagonize other members. [granted, the owner is not specified but I digress, no one thought it would need to be. Consider that the OWNER is included as well.]

And specifically Re: WS Admins, Moderators and their actions (which I am pretty darn sure the OWNER was unspoken, but to be assumed)

Realize that a lot goes on behind the scenes. If you are thinking to yourself "Those moderators are either total idiots or they know something I do not", it's safe to assume we know something you do not.

 

[IQuestion]

This is plausible if they billed insurance and Medicare directly, it's a fairly common scheme with Medicare in fact, but since they didn't bill and the patients had to submit I don't see it working. The prescriptions don't make sense either IMO because the suppliers don't fill right to the dr office, the patient still has to go to a pharmacy. I mean I'm sure there may be other ways to commit fraud but I'm not sue what they'd be

LVSAMYSTERY On the surface it would seem patients have to go to a pharmacy....but, what happens if a PATIENT IS NOT AMBULATORY? Or even worse, a clients account is billed for something they never needed or received? I did a little "google" to see what was going on in the "geographic area."....apparently lots of different ways to scam the system. Access to the right patient information, a smart computer person could do such a thing. After watching the 2 minute video posted below...I think it just might be possible. Would love feedback from other posters, too!
http://www.nbcmiami.com/news/local/...deral-Medicare-Fraud-Crackdown-308237531.html

 

[DexterMorgan]

Could the IT genius make up the clients and bill Medicare with the fake clients? How does a medical practice get working with Medicare?

Every time I go to the doctor, I get a printout from Medicare so he could not use real people unless he made some kind of fake address for the info . But how many fake addresses can you make?

Good point. I wonder if TS had patients in MO that she didn't know she had.

 

[FelicityLemon]

I dont understand why he hasn't complied and gotten the records out. He can get in trouble for it. Unless you are on to something and there is stuff in their records they arent aware of. Drugs prescribed? Maybe they were ordering drugs and selling them and adding them to patients charts unknown to them?


edited. IDK tho. That would have been risky and TS would have seen it in their charts.

True, TS would have seen it unless it was done in a way not apparent to casual view. I wonder if it's possible to have a second set of medical records like in bookkeeping skimming? Much easier to get away with in an all-cash business. I logged into my health insurance today and was amazed at what records are there. So far, I don't have a problem with it because it's useful to me, too. I see all my prescrips, records of dates, prices, dr. appointments, charges, etc.

Since LE has been going through the records, they'll know by now who received scrips and for what. If there are any inconsistencies, DEA is on it.

 

[LvsAMystry]

Could the IT genius make up the clients and bill Medicare with the fake clients? How does a medical practice get working with Medicare?

Every time I go to the doctor, I get a printout from Medicare so he could not use real people unless he made some kind of fake address for the info . But how many fake addresses can you make?

I don't find it plausible with fake patients but idk. Typically it's seen when a practice does bill Medicare directly and they just add on services that were never performed, thus the add ons are 100% profit bc the service was never performed. They get away with it bc the patient has no part in the billing process and most wouldn't notice the add ons.

Now I suppose fake patients are possible and they could submit billing only in those instances and not for the actual patients, but the fake patients would still have to have SS numbers etc that have Medicare participation so that's why it doesn't seem as feasible since more variables could go wrong.

 

[human]

I don't find it plausible with fake patients but idk. Typically it's seen when a practice does bill Medicare directly and they just add on services that were never performed, thus the add ons are 100% profit bc the service was never performed. They get away with it bc the patient has no part in the billing process and most wouldn't notice the add ons.

Now I suppose fake patients are possible and they could submit billing only in those instances and not for the actual patients, but the fake patients would still have to have SS numbers etc that have Medicare participation so that's why it doesn't seem as feasible since more variables could go wrong.

I don't get how the Medicare fraud works because as I said, I get a printout mailed to me each time I go to the doc. It tells me the service, what was paid and what I owe. I have an insurance policy as well.

Are the people involved in the Medicare fraud?

Someone has to explain it to me please.

I bet anything the clinic has some kind of monkey business going on. CWW is not doing it out of the goodness of his heart. And he is not flying there for peanuts.

What is the scam because there is one.

 

[LvsAMystry]

LVSAMYSTERY On the surface it would seem patients have to go to a pharmacy....but, what happens if a PATIENT IS NOT AMBULATORY? Or even worse, a clients account is billed for something they never needed or received? I did a little "google" to see what was going on in the "geographic area."....apparently lots of different ways to scam the system. Access to the right patient information, a smart computer person could do such a thing. After watching the 2 minute video posted below...I think it just might be possible. Would love feedback from other posters, too!
http://www.nbcmiami.com/news/local/...deral-Medicare-Fraud-Crackdown-308237531.html

I guess it depends, the RX or script is the point of origination for medication at the dr office or facility yes, but even though TS or practice for her services were cash only its still likely the majority of her patients if not all were covered by insurances that have their own prescription vendor programs they'd go through to have them covered. There are only a select few left as they're swallowing each other up a la telephone bell companies remember those? But anyway, if like in your example the patient is unable to go to the pharmacy the pharmacy vendor would send via mail order supply direct to patient address. Again though anything is possible but I don't see it as large scale or long term lucrative too many checks and balances

Eta the article you linked is the scenario I mentioned in the last post billing 100% fraud charges and they could do it bc they had patients complicit in the scheme. There still has to be valid Medicare coverage and I just don't see TS patients complicit in it

 

[concernedmother]

The motive may be as simple as a huge life insurance that pays more than a divorce would. Plus, you don't have to share the kids. jmo

 

[LvsAMystry]

I don't get how the Medicare fraud works because as I said, I get a printout mailed to me each time I go to the doc. It tells me the service, what was paid and what I owe. I have an insurance policy as well.

Are the people involved in the Medicare fraud?

Someone has to explain it to me please.

I bet anything the clinic has some kind of monkey business going on. CWW is not doing it out of the goodness of his heart. And he is not flying there for peanuts.

What is the scam because there is one.

I would say the person would either need to be involved or just not scrutinize their bill. But that's just my opinion, there could be countless ways around things that I'm unaware of I'm sure

 

[LvsAMystry]

The motive may be as simple as a huge life insurance that pays more than a divorce would. Plus, you don't have to share the kids. jmo

And then take the med school loans out of the financial equation too

 

[DexterMorgan]

I wonder who did the medical transcriptions in the office.

 

[IQuestion]

Good point. I wonder if TS had patients in MO that she didn't know she had.

DM Or even worse patients who weren't aware, either! (quoting from this linked article):

"some clinic operators also sold batches of fabricated prescriptions that Medicare patients didn’t even know about — distributing them like a “drive-thru” business, authorities say, to be used for filing fraudulent claims.'

and, "In 2013, ProPublica reporters highlighted the vulnerability of the Part D program, noting that insurance companies must pay for prescriptions issued by any licensed prescriber and filled by any willing pharmacy within 14 days.

Read more here: http://www.miamiherald.com/news/local/community/miami-dade/article24842470.html#storylink=cpy
I have no direct knowledge as I am not eligible for medicare....so I don't know the vulnerabilities of the system...but I imagined it can be complicated by some people who live seasonally in Florida and the rest of the year in another state. How does that work if you run out of meds while in Florida, but your winter residence (normal mailing address) is in Maine or Missouri?

 

[Timekeeper65]

"How does that work if you run out of meds while in Florida, but your winter residence (normal mailing address) is in Maine or Missouri?"

IQuestion, the big box pharmacies will transfer prescriptions from one pharmacy to another. Example: Walmart will transfer certain RXs to CVS. Even easier if the patient uses Walmart in Missouri and Florida, interchangeable.