Rachelle S. writes
My health system pays money to each Medicare Advantage Special Needs Plan patient who keeps their appointment. I know this is wrong from my compliance training and I’m afraid I’m going to get in trouble for seeing them. What should I do?
Rachelle, this is not an uncommon practice among health systems trying to cash in on the high payments associated with dual-eligibles under special needs plans.
If you report, expect to be retaliated against. If you don’t report the situation you theoretically can be held criminally liable. It’s your name on the Medicare contract.
I say theoretically because if the situation ever is investigated the organization will probably get off with a fine. It is rare indeed that individuals get punished—especially in large health systems with political influence bought and paid for through their revenues.
That said, you still could be left holding the bag. It’s rare, but it happens.
If you report the situation to your compliance officer then do so by email. forward a carbon copy to your personal email. Make sure that email has no privileged health information about patients within it.
And prepare for retaliation. New job descriptions, harassment over your work product, placement on a Performance Improvement Plan.
As a young clinician, best not to make any waves and find a new job. One with a system that doesn’t use payola to further corporate interests.
You’ll sleep better.