Deliberate Ignorance

So, my simple cold evolved into laryngitis, which although harmless, impressively took my voice away and I was excused from work on Thursday so that I wouldn’t scare the patients. This conveniently occurred after having been given all of Wednesday off and wisely spending the day getting a pedicure and my car detailed! My voice is almost back to normal now, and other than an impressive display of purulent, green mucus in the morning when I wake up, I am feeling pretty good. On Friday we only had one case, and I was dismissed immediately after intubating the patient. I believe that I worked a total of four hours this past week, plus another eight hours of driving to and from locations all over town. Perhaps I should have considered anesthesia more seriously as a career…

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I start yet another rotation on Monday. For some reason, this time one of the local hospitals is requiring me to go through their compliance training. Luckily, the training was all conducted online. However, I spent almost two hours this morning covering such fun topics as fraudulent billing practices and “anti-kickback” laws. Not exactly how I had planned on spending my Saturday, but given my penchant for procrastination, I guess it is entirely my own fault. I did think that the jeopardy session and memory game for matching protected health information topics with their question stems was ridiculous. For all of you computer programmers out there (including my older brother): there is NO POSSIBLE WAY to make this stuff entertaining! I think it is fair to say that most of us would rather just pretend to read the information and take a stab at the online examinations without being forced to play games that may or may not have involved animated fax-machines and paper shredders.

However, I did enjoy the segment on deliberate ignorance. Apparently, not only is it a crime to double-bill people or submit bills for services not rendered, but you also cannot refuse to keep current on billing practices and play dumb. Failure to keep current on coding is labeled “deliberate ignorance” and also subject to penalty by law. So basically, the government's standpoint is: Get the billing done right or else we will either fine you for being a fraud or a dumbass!

As a medical student, I basically pop in and out of patient’s rooms and write progress notes. I never see any part of the actual billing. The preceptor simply signs my note in the chart and then informs his/her office what level of care to bill the hospital visit as. I believe that physicians employed by the hospital have some similar process of logging their work. So for me, I found it somewhat odd to be perusing literature on when to suspect that a physician was turning in fraudulent claims, or what kind of internal referral practices are unethical. Why are they training a whole army of employees to watch over the behavior of physicians? It was almost like an “Us vs. Them” scenario in which I was reading top-secret info from the other side. The training program kept mentioning how nurses, clerks, and physicians could all get themselves into trouble and ultimately result in the facility not receiving reimbursement for Medicare/Medicaid patients, but it clearly leaned towards physicians being the deliberate perpetuators. Interesting, and almost enough to make one paranoid, but then again, my interpretative skills could be a little off right now due to the Nyquil.