Wednesday, August 22, 2012

Plastic surgeon in trouble for aggressive billing practices


There’s a big Internet dustup about a California plastic surgeon who is being sued by the state to stop her aggressive billing practices. The state medical board is investigating her for possible illegal balance billing and may remove her medical license.

The LA Times ran a story documenting the plight of a patient who cut off the tip of a finger. In the emergency department, he requested the services of a plastic surgeon. The doctor saw the patient and had him sign an agreement to pay for what she was about to do.

It is not clear exactly what was done in this case, but apparently, all the work took place in the ED. The surgeon billed the patient $12,630.00 and received $3500.00 from the patient’s insurance carrier, which she refused to accept. She billed the patient for the entire amount and sued him when he didn’t pay. She also started a process to force the patient to sell his house in order to pay her.

Some doctors are defending the surgeon. For example, the blog White Coat Call Room said, “Suing a doctor and trying to revoke her license because she wants to get paid the asking price for her services? If people don’t want to pay her price, then don’t use her. Go see another ‘professional.’”

The LA Times article was posted on Sermo [free registration required & restricted to licensed MDs] and has yielded over 280 comments, a large majority of which are sympathetic to the surgeon.

There’s a lot more to this than you think.

Some have pointed out that patients often request a plastic surgeon unnecessarily. I agree with that. But such consults are often instigated by the ED staff and no discussion of costs or fees ever takes place. I spent 24 years as a surgical department chairman fielding complaints about this sort of case from both patients and surgeons.

Although the patient may have agreed to pay the surgeon, it is not clear from the LA Times account that he was made aware of what the fee would be before signing.

Some have suggested that because the surgeon was “out of network,” she could bill whatever she wanted to. Nonsense. She was covering the ED. She had an obligation to treat emergencies. Fees must be reasonable.

The fee of over $12,000.00 is outrageous for any procedure done in an ED and particularly for what seems to have been a simple fingertip repair. The $3500.00 payment from the patient’s insurance company seems quite generous to me.

The surgeon has a pattern of this behavior having filed more than 50 breach of contract lawsuits since 2010.

Most damning of all, the LA Times notes, “She attended law school at UC Berkeley, though she is not licensed to practice law in California.” Too bad. She would be a great lawyer.

To me, the plastic surgeon is simply greedy.

These are the kinds of stories that make all doctors look bad. Is it any wonder that people resent us and don’t respect us as much as they once did?

18 comments:

Dr Skeptic said...

Agree. People can expect to be paid when (what we call) a financial consent has been signed, detailing the costs - it is hard to argue with that. But an open ended agreement doesn't hold up in my country and doctors are aware that patients cannot be forced to pay unless they have signed a financial agreement (unless it goes directly to the insurer at regulated rates)

If I tell you I have to kill you said...

It's a free market. If the patient was unwilling to pay whatever fee was required he should have inquired as to the price. While I agree that $3500 seems like a reasonable fee(a hell of a lot more than I would get for the same work using the same materials), the patient signed up for the procedure.

Anonymous said...

I've worked in the medical field as an Administrator and unless things have changed dramatically, the physicians sign an agreement with the insurance carrier to accept fee-for-service, which means that they do not collect anything from the patient accept a co-payment.

Anonymous said...

I am glad that I practice in Canada, and never have to ask to a patient if they can afford surgery.

Skeptical Scalpel said...

Thanks for the comments. In my 40 years in the business, no one has ever asked me what I charge for any service. I do only emergency surgery now and I can assure you that patients do not bring this subject up in the ED.

I doubt very much that the patient in the above situation knew that the fee would be $12K. I think he was naive and she was pulling a scam that had worked many times before, which was have him sign the paper and then bill an exorbitant amount. What if she had billed him for $50K? Would it still be OK for her to sue him and try to take his house?

Seth Trueger said...

re: If I tell you I have to kill you

it's not a free market. there is a lot of asymmetry of information -- the "hidden" cost of repair, medical expertise, etc. Plus the coercive nature of acute illness.

Martin Young said...

$12000 for a finger tip injury? You're kidding me! This is extortion, plain and simple.

Anonymous said...

The California Medical Board is petitioning to revoke this doctor's license. Not just for her balance billing habit, but also several incompetence and negligence charges.

medical board accusations:

http://tinyurl.com/92etkr4

http://tinyurl.com/9e32zyq


Just A Patient in L.A.

Skeptical Scalpel said...

Thanks for commenting. I agree the story is complex and the fee was excessive. The links provided give more information. The surgery on the finger was an OR case. It may have been more complicated than I thought.

However, it is illegal to balance bill in California. Case closed.

The links describe several situations where the pursuit of the payment was over the top but I only saw one case of apparent negligence.

Nancy Ehrlich Lapid said...

The L.A. Times article says "Ron Shinkman, who wrote about Martello and her tactics in the trade publication Payers & Providers, said he had never seen a more litigious doctor in 19 years of healthcare reporting."

WHY is the hospital still letting this doctor cover the ER?

Anonymous said...

Can't she just repossess the finger tip? :-)

Skeptical Scalpel said...

Thanks for commenting. The surgeon is no longer taking emergency call at that hospital.

It's not clear whether the fingertip was put back on or not. It's a good suggestion though.

Nicholas said...

Agree with Seth. I am a defender of free markets, but the point that some people are missing is that the doctor isn't operating within a free market.

Excessive regulation, supply restrictions on MD training and residency spots, et cetera allow the plastic surgeon essentially to be a monopolist in this case.

(BTW I am a surgeon-in-training)

Skeptical Scalpel said...

Nicholas, I agree. It's not a free market. State law in California forbids balance billing. No matter what she does or says, she has violated the law.

Plastic Surgeon said...

Undergoing a plastic surgery can be very expensive for a person. The surgeons at times charge very high as per their will.

Anonymous said...

I would love to know how she coded what she did. $3500 is excessive for a fingertip. I say this as a board certified hand surgeon practicing in NY. Docs like her taint us all.

Skeptical Scalpel said...

I had posted this blog on Sermo, a physician-only site. You would be amazed at the many docs who had no problem with the $12,000 bill and defended her right to charge whatever she wanted.

Skeptical Scalpel said...

In case anyone is interested, the doctor in question was fined $562,000 and sentenced to 5 days in jail. http://www.latimes.com/business/money/la-fi-mo-doctor-balance-billing-case-20131205,0,4955388.story#axzz2mir6UTqQ

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