Fraud in medicine: mail order pharmacies

My clinic refuses to fax to mail order pharmacies. Instead, I give the prescription to the patient and tell them to mail it.

I started this policy over a year ago, when five different patients called in the same week, about two mail order pharmacies.

Patient: “I called my mail order. They say that they don’t have the prescription and the doctor just needs to cal.”

I check. Each of the prescriptions had been faxed. I called the two companies a total of five times that week. Each time they would ask for my identifying information, the patient’s identifying information, transfer me and then say, “Oh, yes, we have the prescription.”

Ah. This is a nice example of triangulation. The patient calls for their refill. The mail order company faxes me a request. I check the chart, see if the person is due for labs or a visit, and fax the prescription. Then the company sits on it. The patient calls them and the company says they don’t have it. They delay. Finally the patient calls me to call the company and then the company admits, oh, yes, actually we do have it.

So we refuse to fax to these companies.

Last week I saw a patient who had mailed her prescriptions. She did not get her medicine.

“I called the company five times. They told me they didn’t have it. They said to call you to send a “hard copy”. I said, “I mailed it to you myself on this date.” Then they said, “Oh, yes, we have it.” However she was out of her medicine for three weeks.

I said, “They saved the cost of three weeks of medicine. That is fraud.” I explained the scam.

Comprehension dawned on her face. “They do it on purpose?”

I shrug. “Five in one week seems like a business operation to me. I recommend that you write to the state insurance commissioner.

She said, “Next time I will mail it certified. And yes, I will call the insurance commissioner if they do it again.

The patient main insurance sends information that getting the prescriptions mail order will be cheaper, and so people want to use the mail order: but the mail order pharmacies in our area are saving costs by ripping people off and delaying prescribed medicine. I do hope they end up in jail: if we can’t jail the corporation, let’s at least jail the CEO and the top 4 officers.

I took the picture yesterday at sunrise.

 

Thoughts on the update from ICD 9 to ICD 10

I would be very interested in a tune for this poem. 

This poem was rejected by JAMA, the Journal of the 
American Medical Association. Of course, the American 
Medical Association writes the codes. I do not look 
forward to going from the present 14,000 diagnosis 
codes to 42,000. I think it's just another way for 
insurance to delay and refuse to pay physicians. I 
think our country now has a business ethic of "screw 
anyone you can" and I don't like it. 

Thoughts on the update from ICD 9 to ICD 10


They say ICD 9
Just isn't so fine
Not enough codes to choose
To keep us fungking confused

They say ICD 9
Just isn't so fine
The rest of the world
Uses ICD 10, word

But they are liar liar liars
Pants on fire fire
Noses as long as telephone wires

They are liar liar liars
Fungk ICD 10
And let me tell you fungk them
Fungk starting over again

ICD 9 is now 34
Oh what a bore
They say it's too old
I'm older and gold

They say engage a team
Establish a plan
Get focused training
Learn that sh-t from the man

They say what does your practice
See and learn just those codes
Fungk ya'll but wise
I see everything that goes

I do family practice
I'm a rural doctor
The point of the codes
Is insurance don't pay, suckers

They say ICD 9
Just isn't so fine
The rest of the world
Uses ICD 10, word

But they are liars liars liars
Pants on fire fire
Noses as long as telephone wires

I know my ICD 9
Forwards and backwards, up and down
I can code pregnant
by four circus clowns

I can code pulmonary
embolus past
I can code gerbil inserted in the a--

ICD 10
is starting again
Code left or right or other
Those sh-ts would fungk your mother

ICD 10 is starting again
Code where it happened
Or insurance won't pay
Fungkers make my day

They say champion the change
I say channel the rage
Take a book from my page
Incinerate the fungking change

Fungk ICD 10
Fungk ICD 10
Fungk ICD 10
Fungk it again.