Fraud in medicine: Veterans Choice

Yesterday I tried another tack to get paid for seeing Veterans Choice patients.

We are more than 40 miles from the nearest Veterans Hospital. Starting May of 2015, I was called by the Veterans administration to ask if I would accept a veteran as a patient. I said yes. I have seven by now, but we are currently refusing to take more.

That is, I can see them, but so far I have not been paid a penny.

The VA sends me an authorization from Triwest, the (for profit) contractor in the Northwest region, I see the patient, I fax my note and everything to Triwest, I fill out forms for referrals…. my biller follows Triwest’s instructions…. and they do not pay us. Over 25 visits now, over $5000.00

I have called Triwest, I have written to my senator and representative, I have called and called….

Yesterday I looked at this site: http://www.va.gov/

From there to the US map: http://www.va.gov/directory/guide/division.asp?dnum=1&isFlash=0.

We are district 20: http://www.va.gov/directory/guide/region.asp?map=1&ID=20

VA Puget Sound Seattle: http://www.pugetsound.va.gov/

Under “about us” a dropdown menu to the leadership team: http://www.pugetsound.va.gov/about/leadership.asp

And I called the office of William H. Campbell, MD, FACHE | 206-277-1330, chief of staff, third one down.

The administrative assistant who answered asked if he was expecting my call.

No, I said and explained. I said that I very much like my veterans and would like to continue to work with them but as the owner, CEO and sole physician in a small business, I do need to get paid. Please help.

She put me on hold. And then I spoke to Dr. Campbell and explained again. I said that I am not getting paid, we have contacted Triwest multiple times and followed their instructions, when I call Veterans Choice the response I get is “I don’t know.” and that my patients can’t get their mail order refills because even though the VA called me to see the patient, I am not “entered” in to their pharmacy system.

Later I got a call from a person who promised to speak to Triwest and expedite payment.

I got a call from the head of pharmacy at the Seattle VA.

Who knows? I might, someday, get a check from Triwest.

The issue is really that this is not an isolated problem. All of the insurances are getting worse. I get postcards from 50 different insurance programs a month telling me how they have changed their benefits for the different plans and inviting me to go on line and read their detailed instructions. Noridian, the northwest for profit contractor for medicare, held my payments for 5 months last year because they were getting audited and suddenly realized that my application and everyone else’s had been wrong for years. Doctors are quitting all over the Olympic Peninsula and I suspect all over the United States. At this point I do not think anyone could DESIGN a more unintelligent, arcane, frustrating system. And if you see a US doctor, half of their staff is there to go on line or on the phone to get prior authorization to get a CT scan, get an MRI, see a specialist. And the paperwork for every lab, every insurance company, every xray, every physical therapy office is DIFFERENT: tell me, is this efficient? No, but someone is making a huge amount of money and it is certainly not me. I want my health care dollar to go to health, not to stupidity and not to corporate profit.

And I am wondering if it is worth it……

I took the photo of the trees and bunkers at Fort Worden in 2005.