For the record I have still not received any response to my letter to Secretary Aldona Vos, or Governor Pat McCrory. The letter was mailed on April 24, 2014.
My last few posts were focused on Dr. Larry Joe Russell and his Medicare billing practices. The reason for that is the newly released numbers, posted by the CMS (Centers for Medicare and Medicaid Services). According to CMS the reason they are posting these numbers is so people can find and report Medicare fraud. Seems like a great idea, if they actually intend to take any complaints serious.
My first encounter with CMS was almost two years ago. I was referred to them by then Congressman Heath Shuler's office. The initial reply from CMS starts with how they appreciate concerned citizens who report Medicare fraud. Then it goes on to tell how seriously they take these allegations. When you look at the amount of taxpayer dollars spent on Medicare, they should be taken serious. That letter was from Alfreda Walker out of the Atlanta office of CMS. The letter goes on to say that I will be contacted directly by someone from their office. It also says that I will be contacted by someone from a State agency, concerning Medicaid. Four months went by an I never heard from anyone.
I contacted the Congressman's office and apparently somebody dropped the ball. Turns out it never left Ms. Walkers office. My phone call made something happen, but I'm not sure what. The next communication I received was from NCI Advancemed. The letter I got stated that they had completed their investigation and appropriate action had been taken. I called the number on the letter and spoke to Shannon Stinedurf, the one who had signed the letter. I asked her what action had been taken. Her reply was " there was no action taken, we didn't find anything wrong ". This prompted me to contact Ms. Walker again. She explained that NCI Advancemed was the contractor that handled Medicare fraud investigations. I asked her how they had conducted an investigation without ever contacting me for my information. Ms Walker failed to explain how this was possible. Then she told me that the "quality of care issue was being handled by the Carolina Centers for Medical Excellence, another contractor. She gave me a number to contact them, but it wasn't the right number. After a couple of emails to the CMS, I finally got a number that worked.
I then Called the CCME , and spoke to a representative that listened to my story. The representative seemed to think that there were several issues of concern in what I told her. She said she would pass things on to someone who would conduct a review. It only took a week or so, and I received the letter saying they did not find anything wrong. I tried to contact the first person I had spoken to, and could not get her on the phone. Things were getting more and more confusing.
Both the CCME and NCI Advancemed were government contractors, and both conducted their " investigations " in record time. Neither of them contacted me for any information nor did they seem to be concerned with what I had told them. Being the persistent person that I am, the next step was to call NCI Advancemed and start the move up the chain of command. I finally ended up with Norma Elder, who informed me that they had never been contacted by CMS, Congressman Shulers office or me. They got their information from the NCDMA ( North Carolina Division of Medical Assistance ). The NCDMA got their information from a complaint I had made with the NC Medical Board.
All of these different agencies had done nothing till my call to Congressman Shuler's office. Then they all seemed to find nothing wrong at the same time. I am convinced that someone with serious influence is controlling how this turns out.
If this seems confusing to you, welcome to the club. I have never been politically active, nor have I ever been so disappointed in the United States government. It seems that our government has decided that they are so incompetent they have to use contractors. It would not be surprising to know that the same contractors are owned by politicians and their family members. Probably the same people who own nursing home groups.
Sunday, May 25, 2014
Sunday, May 18, 2014
Is Dr. Larry Joe Russell stealing from Medicare? You be the judge
In my last post I gave numbers of referrals to and from local Doctors. I have researched the data, and according to the website, the numbers come from the Federal Government. I can not confirm the source, but it appears to be based on Medicare billing.
I have recently been directed by a government official to a Wall Street Journal site that posts the amount doctors billed Medicare for in 2012. According to an official from CMS, it is easier to navigate than the CMS site. According to the Wall Street Journal website, Dr. Larry Joe Russell billed Medicare for 5000 patient visits. That's ninety six visits a week if he works fifty two weeks a year. Keep in mind that Dr. Russell also accepts Medicaid ,private insurance and cash patients. That's a lot of patients. According to the Wall Street Journal Page, Dr. Russell saw more Medicare patients than all but two other doctors in the county.
According to the NC Medical Board, in 2012 Dr. Russell supervised nine nurse practitioners, and one physicians assistant. Using the information from the Wall Street Journal website together with Dr. Russell this group had 13,575 patient visits. That's 261 patient visits a week, and that's a conservative number based on the information provided. Keep in mind that they also see patients other than Medicare. According to the website that totals around $856,893.04 Medicare dollars. That's $16,478.71 cents a week, not considering any business other than Medicare.
In my opinion, that seems excessive at any level. I understand that doctors, nurses and physicians assistants have a right to make a living. It just stands out that according to the WSJ website, Dr. Russell was the number one Medicare biller under family practice physicians, with over $419,425.00 in 2012. Next look at physicians assistants, Martha K. Hoffman, Dr. Russell's Pa. is second on the list with $60,089.00. Last if you look at nurse practitioners, Denise Hunt was #1 at 138,333.00 , #2 was Linda Brooks at $104,658.00, # 4 was Deborah Whitmire Pittillo at $62,461.00 and at #5 was Alicia K Younger at $45,772.00. Four out of the top five Medicare billers are supervised by Dr. Larry J Russell.
Out of two hundred family practice physicians, Dr. Russell is the thirteenth highest Medicare biller in the State of North Carolina. I realize that this doesn't actually prove anything illegal. I don't know Dr. Russell personally, but I know people who do. Based on what I do know, Dr. Russell is not seeing all these patients as a community service. I also know that he does not actually " see " all of these patients.
Does all of this information prove Dr. Russell is breaking any laws ? I've been told that it does not. Should the authorities be watching him, I would hope so. I would assume that if you were going to audit a certain group, you would look real hard at the number one on the list.
If Dr. Russell is your doctor, you might want to reconsider what you are getting for your money. The numbers above are Medicare only. If you are not one of those 261 Medicare patients, then you are somewhere between 262, and ????
Here is the link to the Wall Street Journal website mentioned above. Just out of curiosity, put your doctor in and see how he ranks next to Dr. Larry Joe Russell.
http://projects.wsj.com/medicarebilling
Also, for the record, I have still not received any response from Aldona Vos, Pat McCrory or anyone else that received my letter. The letter was sent out on April 24, 2014.
I have recently been directed by a government official to a Wall Street Journal site that posts the amount doctors billed Medicare for in 2012. According to an official from CMS, it is easier to navigate than the CMS site. According to the Wall Street Journal website, Dr. Larry Joe Russell billed Medicare for 5000 patient visits. That's ninety six visits a week if he works fifty two weeks a year. Keep in mind that Dr. Russell also accepts Medicaid ,private insurance and cash patients. That's a lot of patients. According to the Wall Street Journal Page, Dr. Russell saw more Medicare patients than all but two other doctors in the county.
According to the NC Medical Board, in 2012 Dr. Russell supervised nine nurse practitioners, and one physicians assistant. Using the information from the Wall Street Journal website together with Dr. Russell this group had 13,575 patient visits. That's 261 patient visits a week, and that's a conservative number based on the information provided. Keep in mind that they also see patients other than Medicare. According to the website that totals around $856,893.04 Medicare dollars. That's $16,478.71 cents a week, not considering any business other than Medicare.
In my opinion, that seems excessive at any level. I understand that doctors, nurses and physicians assistants have a right to make a living. It just stands out that according to the WSJ website, Dr. Russell was the number one Medicare biller under family practice physicians, with over $419,425.00 in 2012. Next look at physicians assistants, Martha K. Hoffman, Dr. Russell's Pa. is second on the list with $60,089.00. Last if you look at nurse practitioners, Denise Hunt was #1 at 138,333.00 , #2 was Linda Brooks at $104,658.00, # 4 was Deborah Whitmire Pittillo at $62,461.00 and at #5 was Alicia K Younger at $45,772.00. Four out of the top five Medicare billers are supervised by Dr. Larry J Russell.
Out of two hundred family practice physicians, Dr. Russell is the thirteenth highest Medicare biller in the State of North Carolina. I realize that this doesn't actually prove anything illegal. I don't know Dr. Russell personally, but I know people who do. Based on what I do know, Dr. Russell is not seeing all these patients as a community service. I also know that he does not actually " see " all of these patients.
Does all of this information prove Dr. Russell is breaking any laws ? I've been told that it does not. Should the authorities be watching him, I would hope so. I would assume that if you were going to audit a certain group, you would look real hard at the number one on the list.
If Dr. Russell is your doctor, you might want to reconsider what you are getting for your money. The numbers above are Medicare only. If you are not one of those 261 Medicare patients, then you are somewhere between 262, and ????
Here is the link to the Wall Street Journal website mentioned above. Just out of curiosity, put your doctor in and see how he ranks next to Dr. Larry Joe Russell.
http://projects.wsj.com/medicarebilling
Also, for the record, I have still not received any response from Aldona Vos, Pat McCrory or anyone else that received my letter. The letter was sent out on April 24, 2014.
Saturday, May 10, 2014
Aldona Vos, and the Letter. Unreasonable, you be the judge!
It has been over two weeks since my letter to Dr. Aldona Vos, Secretary of the NCDHHS. I have still not received a reply. The same letter was sent to Governor Pat McCrory, Kathleen Sebelius and members of Congress. I have not received a reply from anyone. As a citizen of the United States and a Taxpayer, I should at least be entitled to a response.
This is routine when dealing with politicians, the first contact you will get a letter thanking you for your concern. Then the letter will tell you about all the fascinating things the politician has done, and how great they are. Then they will close with, " If I can be of any further assistance, please feel free to contact me ". They fail to even specify what you have written about. I received similar letters from almost everyone that I have reached out to, including the President.
Rather than writing what I asked for in the letter I am going to post it below. Are the requests I make unreasonable, you be the judge.
April 20, 2014
Dr. Aldona Vos
Secretary NCDHHS
2001 Mail Service Center
Raleigh, NC 27699-2001
Dear Secretary Vos:
I am writing to ask for your assistance in obtaining information from the NCDHSR. I am trying to get clarification concerning an investigation conducted as a result of a complaint I filed. Twice I have written to Beverly Speroff, Division Chief of the NCDHSR, and been denied.
Complaints were filed by my brother and I concerning the care our mother received at Hendersonville Health and Rehabilitation. The NCDHSR investigation was conducted on January 18 and 19 of 2011. Results of the investigation found no deficiencies. We had obtained a copy of mom’s medical records and found several issues that should have been addressed. After receiving the results, we met with Gail Maloney, who was then the Western Regional Director of the NCDHSR. Ms. Maloney was presented with a list of concerns we had with the records. The number of inaccuracies contained in the records was overwhelming.
One of the main issues was a nurse’s note concerning a fall; the note was a late entry and was written a month after the fall occurred. We obtained a written notarized statement from the patient that was in the other bed at the time. The roommate’s statement was quite different from one given in the “late entry” nurse’s note. Mom had undergone a craniotomy in September of 2011. She had been admitted to Hendersonville Health October 19, 2011 for physical and occupational rehabilitation. According to the records, she had reached her goals and was ready to be discharged on November 3, 2011. That morning she was found not breathing and without a pulse; she died a little before six am.
At the suggestion of Ms. Maloney, I filed a foia request of the results of the investigation. I did not receive the results from the foia until June 10, 2013. The documents from the investigation and the so called administrative review are full of inaccuracies and false information. The packet contains three different letters written by the doctor that conducted the review. Not one of the letters contains an accurate account of what is contained in the investigation documents. The lead investigator’s summary contains several conflicting statements; one concerning the fall mom sustained.
All I am asking for is clarification of what is contained in the investigation documents. If there are other pages proving what is stated, they are not in the report. As a United States citizen and a tax paying resident of the State of North Carolina, I should be entitled to the information I am requesting. I am not asking for a citation to be written against Hendersonville Health and Rehabilitation but my goal is to call attention to a possible flaw in the investigation process. This is extremely important because these investigations result in the licensing and certification of nursing homes. The results are also posted on Medicare.gov to be used as a tool by citizens trying to choose a nursing home.
Since the beginning of my involvement with the NCDHSR, I have been treated in an adversarial manner. I would question if this is not in some way a violation of Title 18, U.S.C., Section 242. If the report contains false information, I believe that it is a violation of Title 42 U.S. Code § 1320a–7b.
I would ask that Ms. Speroff reconsider my request, however according to her this matter is closed. As the Secretary of the NCDHHS, I would hope you would be concerned if the NCDHSR is denying the public representation. I would also assume that other statutes would be violated if the actions, or lack of action on the part of the NCDHSR, result in the loss of human life.
Thank you for your consideration.
Sincerely,
cc:
Beverley Speroff
Kathleen Sebelius
Governor Pat McCrory
Alfreda Walker CMS
Norma Elder NCI Advancemed
Joann Quarles QIO
This is routine when dealing with politicians, the first contact you will get a letter thanking you for your concern. Then the letter will tell you about all the fascinating things the politician has done, and how great they are. Then they will close with, " If I can be of any further assistance, please feel free to contact me ". They fail to even specify what you have written about. I received similar letters from almost everyone that I have reached out to, including the President.
Rather than writing what I asked for in the letter I am going to post it below. Are the requests I make unreasonable, you be the judge.
April 20, 2014
Dr. Aldona Vos
Secretary NCDHHS
2001 Mail Service Center
Raleigh, NC 27699-2001
Dear Secretary Vos:
I am writing to ask for your assistance in obtaining information from the NCDHSR. I am trying to get clarification concerning an investigation conducted as a result of a complaint I filed. Twice I have written to Beverly Speroff, Division Chief of the NCDHSR, and been denied.
Complaints were filed by my brother and I concerning the care our mother received at Hendersonville Health and Rehabilitation. The NCDHSR investigation was conducted on January 18 and 19 of 2011. Results of the investigation found no deficiencies. We had obtained a copy of mom’s medical records and found several issues that should have been addressed. After receiving the results, we met with Gail Maloney, who was then the Western Regional Director of the NCDHSR. Ms. Maloney was presented with a list of concerns we had with the records. The number of inaccuracies contained in the records was overwhelming.
One of the main issues was a nurse’s note concerning a fall; the note was a late entry and was written a month after the fall occurred. We obtained a written notarized statement from the patient that was in the other bed at the time. The roommate’s statement was quite different from one given in the “late entry” nurse’s note. Mom had undergone a craniotomy in September of 2011. She had been admitted to Hendersonville Health October 19, 2011 for physical and occupational rehabilitation. According to the records, she had reached her goals and was ready to be discharged on November 3, 2011. That morning she was found not breathing and without a pulse; she died a little before six am.
At the suggestion of Ms. Maloney, I filed a foia request of the results of the investigation. I did not receive the results from the foia until June 10, 2013. The documents from the investigation and the so called administrative review are full of inaccuracies and false information. The packet contains three different letters written by the doctor that conducted the review. Not one of the letters contains an accurate account of what is contained in the investigation documents. The lead investigator’s summary contains several conflicting statements; one concerning the fall mom sustained.
All I am asking for is clarification of what is contained in the investigation documents. If there are other pages proving what is stated, they are not in the report. As a United States citizen and a tax paying resident of the State of North Carolina, I should be entitled to the information I am requesting. I am not asking for a citation to be written against Hendersonville Health and Rehabilitation but my goal is to call attention to a possible flaw in the investigation process. This is extremely important because these investigations result in the licensing and certification of nursing homes. The results are also posted on Medicare.gov to be used as a tool by citizens trying to choose a nursing home.
Since the beginning of my involvement with the NCDHSR, I have been treated in an adversarial manner. I would question if this is not in some way a violation of Title 18, U.S.C., Section 242. If the report contains false information, I believe that it is a violation of Title 42 U.S. Code § 1320a–7b.
I would ask that Ms. Speroff reconsider my request, however according to her this matter is closed. As the Secretary of the NCDHHS, I would hope you would be concerned if the NCDHSR is denying the public representation. I would also assume that other statutes would be violated if the actions, or lack of action on the part of the NCDHSR, result in the loss of human life.
Thank you for your consideration.
Sincerely,
cc:
Beverley Speroff
Kathleen Sebelius
Governor Pat McCrory
Alfreda Walker CMS
Norma Elder NCI Advancemed
Joann Quarles QIO
Wednesday, May 7, 2014
How many patients can a doctor see in one day? Can you say malpractice!
This is just one of many answers to the question. How many patients can a doctor see in one day. Just to show how outrageous Dr. Larry Joe Russell's referral numbers are! Note the third paragraph!
How many patients can a doctor safely see a day?
Luis Collar, MD Physician
| December 31, 2013
Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness” or, frankly, malpractice.
With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day in the outpatient setting. The truth is, though, no matter how experienced the doctor, no matter how technologically streamlined the practice, one physician can’t maintain medical accuracy at that frenetic a pace. Many physicians like to think they can because they manage to see every patient on their schedule and do their thing. But, in most instances, good medicine simply can’t be practiced in five to seven minutes.
Sure, there are cases where that is all that’s required. A young, healthy patient, a simple physical, or a stable patient that just needs a medication refill can usually be handled that quickly. But I often see physicians trying to care for medically complex, older patients on multiple medications in the same fashion. The rationalization is usually that, with enough experience, one can take care of these patients just as quickly. But the issue, then, becomes precisely what constitutes “handling” a patient.
A patient with a complex medical history always requires more time. Trying to argue otherwise is simply intellectually dishonest. You can’t take a history, no matter how focused, reconcile all current medications looking for undesired interactions or required modifications, review labs, monitor patient progress, look for better therapeutic approaches, address new issues, encourage communication, conduct a thorough physical exam, and spend time on health counseling / preventive care in five to seven minutes. It just can’t be done that quickly with these patients.
I’ve worked in offices where this level of “efficiency” is touted as the future, the result of effectively leveraging new technology. But the truth is, as much as it pains me to say it, it’s just bad medicine. And the argument that a particular practice doesn’t have that many complicated patients is, in most cases, yet another fallacy.
Complicated patients are not to be confused with medically interesting patients. Many of the most common chronic illnesses that find their way into physicians’ offices are, in fact, not interesting or exciting for seasoned medical professionals. After all, diabetes isn’t exactly extraskeletal myxoid chondrosarcoma or any of the “sexy” hemorrhagic fevers, but that doesn’t mean it isn’t an exquisitely complex illness requiring a thorough clinical approach.
So the average primary care physician may not have many “medically interesting” patients, but they probably do have many complex patients. I would argue that if any practice has a significant amount of patients over the age of fifty, then seeing more than about twenty-five to thirty patients a day is irresponsible. Seeing three to four patients an hour yields a number somewhere in that range. And while some patients can be “handled” more quickly than others, once you go above that number in one day you’re entering dangerous territory.
If you look at the available data and the current incidence of obesity, heart disease, hypertension, diabetes, and depression to name a few, then any practice serving patients over the age of fifty must, by definition, have a good number of complex patients. Although common, none of these illnesses are “simple.” Quick refills, not listening, not asking probing questions, shoddy physical exams, not looking for all possible signs and symptoms of disease progression, poor or no counseling, and not actively staying ahead of a disease are all poor practice. More importantly, those practices lead to poorer patient outcomes and increased health care costs in the long run. That is particularly true with this patient population.
The challenge, of course, is that our current system still rewards speed and procedures much more richly than patient interaction and thorough analysis. Although not a new concept, as reimbursement continues to decrease necessarily (Medicare’s pockets aren’t as deep as they used to be) and more patients gain access to the system, addressing the question of “medical speed” will become increasingly important.
Admittedly, the thoughts presented here are only based on anectdotal evidence collected over several years of working with numerous physicians, in multiple settings, and at several different hospitals. However, I do believe there is a trend here. The more “evolved” our health care system becomes, the more pressure is placed on physicians to leverage technology and see more patients, the more bad professional habits are being developed. Technology can help increase efficiency, but it can’t yet replace ample time with an interested, compassionate, well-trained physician. Not every patient requires thirty or forty minutes, but if we’re going to be honest, forty or more patients a day is simply ridiculous.
I would challenge all physicians to honestly evaluate how long they spend with complicated patients. More importantly, I’d be interested in knowing how they define a complex patient. And I would question any definition that doesn’t include even the most common chronic illnesses. No matter how “boring” these may be, their intrinsic complexity and impact on public health certainly justify more than a few minutes of diagnostic effort, even with routine follow-up visits.
I would also encourage all patients to expect more from their doctors than a couple of questions and some quick advice in five to seven minutes. If you’re there for a simple cold, then maybe that approach is appropriate. But if you have a chronic illness and are concerned by some new symptoms or recent changes in your overall health, you should expect much more from an office visit.
And finally, I would encourage all policy makers to recognize the valuable role physicians play in our society. We need policies that encourage them to do their jobs properly instead of punishing them for it. Ultimately, though, it’s up to physicians to choose. I hope they are true to their training and show humility in the face of complex, albeit common, diseases. It’s a shame to simply toss all that “medical school stuff” out the window simply because the system is currently what it is.
How many patients can a doctor safely see a day?
Luis Collar, MD Physician
| December 31, 2013
Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness” or, frankly, malpractice.
With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day in the outpatient setting. The truth is, though, no matter how experienced the doctor, no matter how technologically streamlined the practice, one physician can’t maintain medical accuracy at that frenetic a pace. Many physicians like to think they can because they manage to see every patient on their schedule and do their thing. But, in most instances, good medicine simply can’t be practiced in five to seven minutes.
Sure, there are cases where that is all that’s required. A young, healthy patient, a simple physical, or a stable patient that just needs a medication refill can usually be handled that quickly. But I often see physicians trying to care for medically complex, older patients on multiple medications in the same fashion. The rationalization is usually that, with enough experience, one can take care of these patients just as quickly. But the issue, then, becomes precisely what constitutes “handling” a patient.
A patient with a complex medical history always requires more time. Trying to argue otherwise is simply intellectually dishonest. You can’t take a history, no matter how focused, reconcile all current medications looking for undesired interactions or required modifications, review labs, monitor patient progress, look for better therapeutic approaches, address new issues, encourage communication, conduct a thorough physical exam, and spend time on health counseling / preventive care in five to seven minutes. It just can’t be done that quickly with these patients.
I’ve worked in offices where this level of “efficiency” is touted as the future, the result of effectively leveraging new technology. But the truth is, as much as it pains me to say it, it’s just bad medicine. And the argument that a particular practice doesn’t have that many complicated patients is, in most cases, yet another fallacy.
Complicated patients are not to be confused with medically interesting patients. Many of the most common chronic illnesses that find their way into physicians’ offices are, in fact, not interesting or exciting for seasoned medical professionals. After all, diabetes isn’t exactly extraskeletal myxoid chondrosarcoma or any of the “sexy” hemorrhagic fevers, but that doesn’t mean it isn’t an exquisitely complex illness requiring a thorough clinical approach.
So the average primary care physician may not have many “medically interesting” patients, but they probably do have many complex patients. I would argue that if any practice has a significant amount of patients over the age of fifty, then seeing more than about twenty-five to thirty patients a day is irresponsible. Seeing three to four patients an hour yields a number somewhere in that range. And while some patients can be “handled” more quickly than others, once you go above that number in one day you’re entering dangerous territory.
If you look at the available data and the current incidence of obesity, heart disease, hypertension, diabetes, and depression to name a few, then any practice serving patients over the age of fifty must, by definition, have a good number of complex patients. Although common, none of these illnesses are “simple.” Quick refills, not listening, not asking probing questions, shoddy physical exams, not looking for all possible signs and symptoms of disease progression, poor or no counseling, and not actively staying ahead of a disease are all poor practice. More importantly, those practices lead to poorer patient outcomes and increased health care costs in the long run. That is particularly true with this patient population.
The challenge, of course, is that our current system still rewards speed and procedures much more richly than patient interaction and thorough analysis. Although not a new concept, as reimbursement continues to decrease necessarily (Medicare’s pockets aren’t as deep as they used to be) and more patients gain access to the system, addressing the question of “medical speed” will become increasingly important.
Admittedly, the thoughts presented here are only based on anectdotal evidence collected over several years of working with numerous physicians, in multiple settings, and at several different hospitals. However, I do believe there is a trend here. The more “evolved” our health care system becomes, the more pressure is placed on physicians to leverage technology and see more patients, the more bad professional habits are being developed. Technology can help increase efficiency, but it can’t yet replace ample time with an interested, compassionate, well-trained physician. Not every patient requires thirty or forty minutes, but if we’re going to be honest, forty or more patients a day is simply ridiculous.
I would challenge all physicians to honestly evaluate how long they spend with complicated patients. More importantly, I’d be interested in knowing how they define a complex patient. And I would question any definition that doesn’t include even the most common chronic illnesses. No matter how “boring” these may be, their intrinsic complexity and impact on public health certainly justify more than a few minutes of diagnostic effort, even with routine follow-up visits.
I would also encourage all patients to expect more from their doctors than a couple of questions and some quick advice in five to seven minutes. If you’re there for a simple cold, then maybe that approach is appropriate. But if you have a chronic illness and are concerned by some new symptoms or recent changes in your overall health, you should expect much more from an office visit.
And finally, I would encourage all policy makers to recognize the valuable role physicians play in our society. We need policies that encourage them to do their jobs properly instead of punishing them for it. Ultimately, though, it’s up to physicians to choose. I hope they are true to their training and show humility in the face of complex, albeit common, diseases. It’s a shame to simply toss all that “medical school stuff” out the window simply because the system is currently what it is.
Saturday, May 3, 2014
Dr. Larry Joe Russell and friends. Stealing from Medicare ???
For the record, I have still not received a response to my letter to Dr. Aldona Vos, Secretary of the NCDHHS. Copies of the same letter were sent to Governor Pat McCrory, Kathleen Sebelius, CMS, Beverley Speroff and other officials. I have not received a response from any of the letters I sent.
In the last post I shared a couple of links to a website that posts referral data on doctors. According to the website, the referrals are taken from Medicare billing records. That would indicate that the data does not contain any information concerning private insurance, or Medicaid. It also states that only the top ten referring physicians are listed. That said I am going to post some information given on the website.
This was copied and pasted directly from the website, which I believe is published by the CMS.
"In order to protect patient privacy, the referral data records the number of times two providers billed Medicare for the same patient within a sliding 30-day period, where at least 11 patients were involved in transactions."
Dr. Larry Joe Russell received a total of 429,739 incoming referrals in a three year span. That means an average of 143,246 a year, or 11,937 a week. That's a lot of patients for one small town doctor. But it gets better Dr. Russell also had 315,328 outgoing referrals, 105,109 a year or 2,021 a week. Together that totals 745,067 over a three year period, or, 248,355 a year or 4776 a week. Dr. Russell charges $125.00 for an office visit, that means if the data is correct, Dr. Russell billed Medicare around $93,133,375.00 over the three year period. Red Flag, Red Flag!!! Is nobody monitoring these numbers.
I will post the top five incoming and the top five outgoing sources, in the interest of public awareness. I will post the information from the three years in the data base.
I will begin with the top five outgoing referrals, from Dr. Larry Joe Russell.
2009 2010 2011 Total
Henderson County Hospital ( Pardee ) 11,628 10,150 9894 31,672
Denise Hunt FNP 3437 3166 3791 10,394
Dr Kevan Hansel, BlueSky MD 3254 2656 1593 7,503
Linda Brooks FNP 1036 1718 2575 5,329
Deborah Whitmire Pitillo FNP 2236 0 1878 4,114
For the record, Dr Russell was instrumental in the negotiations of the purchase of Hendersonville Health and Rehabilitation from Pardee Hospital. Also Linda Brooks FNP is one of the owners of Hendersonville Physicians and Associates, the ones who purchased Hendersonville Health and Rehabilitation. Denise Hunt FNP and Deborah Whitmire Pitillo are both under Dr. Russells supervision, according to the NC Medical Board. Dr Kevan Hansel worked in Dr Russels office but is now with BlueSky, who also owns a percentage of Hendersonville Physicians and Associates. Seems like a cozy little group, living off of Medicare Dollars!
Now here are the top five incoming referrals to Dr. Larry Joe Russell.
2009 2010 2012 Total
Henderson County Hospital ( Pardee ) 15,885 14,043 14,073 44,001
Dr. Kevan Hansel, BlueSky MD 4,609 3,396 1,980 9,985
Denise Hunt FNP 2,900 2,411 3,004 8,315
Henderson County EMS 2,586 2,649 2,663 7,898
Hendersonville Health and Rehabilitation 2,440 2,172 2,253 6,865
Looks like friends scratching each others backs, also looks a lot like several violations of the Stark Law and the law prohibiting physicians self referrals. It appears that somehow this little group of friends are exempt from State and Federal laws. Is nobody in law enforcement looking at this. It is all public information, posted by the very agencies that are supposed to enforce the laws.
All of the information posted here was also forwarded to the FBI, OIG, CMS, NCDHHS, DHHS, and members of Congress. Not one reply so far. Who's running the State of North Carolina ? Is it politicians, or the healthcare PAC's and wealthy nursing home owners? What's the difference at this point, the results are the same. People suffering and dying due to the low staff levels, and the high number of patients supposedly seen by the doctors.
Here is the link again to Dr. Larry Joe Russells referral information.
http://w.npidashboard.com/npi/1891772513
In the last post I shared a couple of links to a website that posts referral data on doctors. According to the website, the referrals are taken from Medicare billing records. That would indicate that the data does not contain any information concerning private insurance, or Medicaid. It also states that only the top ten referring physicians are listed. That said I am going to post some information given on the website.
This was copied and pasted directly from the website, which I believe is published by the CMS.
"In order to protect patient privacy, the referral data records the number of times two providers billed Medicare for the same patient within a sliding 30-day period, where at least 11 patients were involved in transactions."
Dr. Larry Joe Russell received a total of 429,739 incoming referrals in a three year span. That means an average of 143,246 a year, or 11,937 a week. That's a lot of patients for one small town doctor. But it gets better Dr. Russell also had 315,328 outgoing referrals, 105,109 a year or 2,021 a week. Together that totals 745,067 over a three year period, or, 248,355 a year or 4776 a week. Dr. Russell charges $125.00 for an office visit, that means if the data is correct, Dr. Russell billed Medicare around $93,133,375.00 over the three year period. Red Flag, Red Flag!!! Is nobody monitoring these numbers.
I will post the top five incoming and the top five outgoing sources, in the interest of public awareness. I will post the information from the three years in the data base.
I will begin with the top five outgoing referrals, from Dr. Larry Joe Russell.
2009 2010 2011 Total
Henderson County Hospital ( Pardee ) 11,628 10,150 9894 31,672
Denise Hunt FNP 3437 3166 3791 10,394
Dr Kevan Hansel, BlueSky MD 3254 2656 1593 7,503
Linda Brooks FNP 1036 1718 2575 5,329
Deborah Whitmire Pitillo FNP 2236 0 1878 4,114
For the record, Dr Russell was instrumental in the negotiations of the purchase of Hendersonville Health and Rehabilitation from Pardee Hospital. Also Linda Brooks FNP is one of the owners of Hendersonville Physicians and Associates, the ones who purchased Hendersonville Health and Rehabilitation. Denise Hunt FNP and Deborah Whitmire Pitillo are both under Dr. Russells supervision, according to the NC Medical Board. Dr Kevan Hansel worked in Dr Russels office but is now with BlueSky, who also owns a percentage of Hendersonville Physicians and Associates. Seems like a cozy little group, living off of Medicare Dollars!
Now here are the top five incoming referrals to Dr. Larry Joe Russell.
2009 2010 2012 Total
Henderson County Hospital ( Pardee ) 15,885 14,043 14,073 44,001
Dr. Kevan Hansel, BlueSky MD 4,609 3,396 1,980 9,985
Denise Hunt FNP 2,900 2,411 3,004 8,315
Henderson County EMS 2,586 2,649 2,663 7,898
Hendersonville Health and Rehabilitation 2,440 2,172 2,253 6,865
Looks like friends scratching each others backs, also looks a lot like several violations of the Stark Law and the law prohibiting physicians self referrals. It appears that somehow this little group of friends are exempt from State and Federal laws. Is nobody in law enforcement looking at this. It is all public information, posted by the very agencies that are supposed to enforce the laws.
All of the information posted here was also forwarded to the FBI, OIG, CMS, NCDHHS, DHHS, and members of Congress. Not one reply so far. Who's running the State of North Carolina ? Is it politicians, or the healthcare PAC's and wealthy nursing home owners? What's the difference at this point, the results are the same. People suffering and dying due to the low staff levels, and the high number of patients supposedly seen by the doctors.
Here is the link again to Dr. Larry Joe Russells referral information.
http://w.npidashboard.com/npi/1891772513
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