Fight Back!

Author: 
Lawrence R. Huntoon, MD, PhD
Article Type: 
President's Page
Issue: 
March/April 2000
Volume Number: 
5
Issue Number: 
2

Beat your plowshares into swords and your pruning hooks into spears;
let the weak man say, "I am a warrior"
Joel 3:10

There comes a time in the lives of otherwise peaceful men that one must fight back against unlawful invaders. The practice of medicine in this country has been unlawfully invaded by a tyrannical HCFA bureaucracy and its army of meddling bureaucrats. They have usurped our clinical judgment via thousands of pages of incomprehensible and often contradictory regulations and have interfered with our ability to serve our patients. They have unlawfully invaded the sacrosanct patient-physician relationship, with the clear intent of destroying it and replacing it with a new relationship dictated by Big Brother.

Now is the time to shape your intelligence, training, experience, skill, time, labor, money, word processors, and photocopiers into weapons to be used against these evil invaders. It's time for doctors to stop playing defense and start playing offense. A full-scale counterattack is long overdue.

The "battle plan" for fighting back, sometimes referred to as "bureaucratic pinball," was developed based upon my vast experience in fighting these government bureaucrats for more than a decade. One of the secrets that I have learned as a seasoned medical warrior is that this government bully has a "glass jaw." His glass jaw is paper. The bully can dish it out, but can't take it when paper is thrust in overwhelming quantities in his direction. Letters of complaint, letters of appeal, letters of inquiry etc., in copious quantities, are the "bullets" that hurt this enemy. Success in battle depends on persistence. Stay in their face; never give up and never back down. Follow the observations, tips and strategies for fighting back as shown below and let the enemy feel the sting of our "sword."

1. There are more of us than there are of them. We have the ability to "break their backs" if we choose to. Be it resolved that we choose to.

2. We're smarter than they are. Use your intelligence, training and experience. You know medicine, they don't.

3. Paper hurts the HCFA/Medicare bureaucracy. Their budget and ability to cope with large quantities of paper (letters, etc.) is limited.

4. Use your word processors as a weapon. It isn't hard to create a library of template letters. There are certain situations, denials for medical necessity etc., that occur over and over again. Medicare uses template letters to deny your claims; there is no reason for you not to use standard template letters to fight them. It's easy to change a few details, patient name, HIC#, date of service in the template letter and fire it back at them quickly and cost-effectively. It's also easy to change the address on these letters so that they can be "personalized" and sent to multiple HCFA and Medicare bureaucrats.

5. Use your photocopiers to convert the above weapon into an "automatic weapon." For every letter that you receive from this evil bureaucracy, you should fire back at least 10 in return. This "multiplication" factor is devastating to the bureaucracy.

6. Counterattack at multiple levels in the bureaucracy. When Medicare clerks wrongfully deny your claims, by all means write them back and protest, but also write letters of complaint against the Medicare carrier to all levels of the bureaucracy.

7. Charge them with health care fraud. Let the enemy turn and fight against itself. When a medically untrained Medicare clerk makes a "medical necessity" decision that adversely affects your ability to serve your patient (claim denial), then they are committing health care fraud. The Medicare carrier is taking money from the government under false pretenses of competently reviewing claims with no intention of ever fulfilling that contractual obligation by virtue of the fact that they routinely allow medically unqualified individuals to make medical necessity decisions. When they send this fraudulent claim denial through the mail, they are also committing mail fraud. And, inasmuch as this is a pervasive scheme to extort money from physicians via fraudulent means, their actions also likely violate the RICO Act. In writing to your Congressmen, emphasize that these government bureaucrats should be held fully accountable for their crimes against you and your patients. Write to all levels of the HCFA bureaucracy, especially Ms. Coralyn Colladay, Esq. of HHS and demand that the carrier and specific personnel involved be turned over to the HHS OIG for prosecution for fraud.

8. Enlist the help of your patients. They are a mighty army that can inflict heavy casualties on the enemy. Use personalized template letters to correspond with patients adversely affected by claim denials and let them know how they will personally be affected if the wrongful decision is allowed to stand --- i.e., they may not be able to get the service that they need in the future. Encourage them to write letters of complaint to the Region HCFA Office and send a copy to your office with permission to copy and distribute their letter to other HCFA bureaucrats and to their Congressmen (with patient name blacked out). Send a cover template letter to the Congressmen along with the patient's complaint explaining what Medicare is doing to you and your patients. By using your "automatic weapon" (photocopier), a single patient letter of complaint can be multiplied at least 10 fold and fired back against these invading bureaucrats. These bureaucrats have a very hard time explaining to Congressmen when both patient and doctor are complaining about the same thing.

9. Appeal everything. Every wrongful claim denial should be vigorously appealed. Do not allow Medicare to take any "free shots" at you. These bureaucrats need to be conditioned such that every time they take a "shot" at you, they receive at least 10 in return plus crossfire from patients and from inquiring Congressmen. Send them lots of paper, cost them lots of money and hurt them. Make no mistake, they are out to hurt you and destroy your ability to make an honest living treating patients. They need to learn that we are not targets in their one way shooting gallery --- "shoot" back.

10. Be persistent. You may not win the first round with the Medicare clerk, but persistence often pays off by reversing an adverse decision. Learn the rules and use them to advantage against the very bureaucracy that promulgated them against you. Use Advance Beneficiary Notices (ABNs) and the provisions available to you under "Limitation of Liability." ABNs can now be used routinely as per the decision in USA v. Shalala. Combine claims to reach the "amount in dispute" required to pursue claims at increasingly higher levels in the appeals process. Never agree to waive your right to a formal review. Request a "re-opening" of claims that have resulted in an adverse decision on appeal.

11. Turn your Medicare carrier medical director into the State Medical Board and charge him or her with gross incompetence if he or she participated in a clinically unsupportable claim decision (often outside his or her area of expertise), a decision which harms your patients. These "Uncle Toms" have been abusing their M.D. degrees for too long, blindly following their employer's commands, and harming our patients in the process. It's time to hold them accountable for their actions.

12. And, last but not least, write and tell us your successes in battle or share other tips you have learned in fighting these evil, unlawful invaders. It will boost the morale of the troops and spur them on to further victories.

Fight back, and may the force of God be with you.

Lawrence R. Huntoon, MD, PhD is president of AAPS and a practicing neurologist in Jamestown, New York.

Originally published in the Medical Sentinel 2000;5(2);42-43. Copyright©2000 Association of American Physicians and Surgeons (AAPS)

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