# More trouble for Houston private EMS



## bigbaldguy (Oct 17, 2011)

http://www.chron.com/news/houston-t...-oversee-EMS-companies-sanctioned-2220861.php


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## JPINFV (Oct 17, 2011)

Hack piece. While physicians currently under sanction or had had major sanctions probably shouldn't be a medical director, even for an IFT, the connection between the medical director and how much medicare dollars an ambulance company brings in is a really tenuous link.


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## Fish (Oct 17, 2011)

Why on Earth would U of H join the Big East Conference? Big 12 all the way!


Oh, and shame on that Dr.


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## WoodyPN (Oct 23, 2011)

Fish said:


> Oh, and shame on that Dr.



It should be shame on that reporter. A terrible article. All it does is try and stir &%$@. Medical directors(most, and at least @ my service) aren't playing some huge role, but if you listened to this guy, it seems like he's running the place.


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## Flight-LP (Oct 23, 2011)

WoodyPN said:


> It should be shame on that reporter. A terrible article. All it does is try and stir &%$@. Medical directors(most, and at least @ my service) aren't playing some huge role, but if you listened to this guy, it seems like he's running the place.



Incorrect!

This reporter is finally exposing what many of us in Houston have known for years, the EMS system needs an overhaul. Too many crappy, unprofessional, unethical, and fraudulent companies have come in and opened shop scewing taxpayers out of their hard earned money. These Medical Directors are supporting federal fraud, period! They know the operations and they are obligated to provide QA and run report review. Physicians like Mack, Echols, and Okese have proven their questionable ethics by exhibiting the behavior that incurred investigation and regulatory action. To make the statement that this article is trying to stir some **** is completely accurate, however you have to recognize that this **** stirring is a much needed and welcomed occurance.

The City of Houston also needs to start regulating the quality level of EMS agencies. The current application procedure does nothing more than put money in the city's pocket. 

Add to these issues, the desperate uneducated EMT who seeks the first ambulance job they can find, and you now have the supply of pawns to meet the fraud demands of the company. This is the next area of improvement that is desperately needed. We must start regulating the supply of EMT's by restricting the quantity of the supply. In other words, stop pushing hundreds of students through every semester when the demand is not present. This would help eliminate the compromise of ethics by individuals who are desperate for the job of their dreams and filled with delusions of the lifesaving skills that an EMT supposibly possesses.

In the words of Jack Nicholson.............This town needs an enema!


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## AlphaButch (Oct 23, 2011)

This problem doesn't belong to the city (although Houston has plenty of other issues involving EMS/Private Ambulance that should be looked at).

The problem involves accountability. If an ambulance service is investigated and found committing fraud, _everyone_ involved in that fraudulent act should be held accountable. Suspend/Fine the MD's license (both the service medical director's and the sending MD), Suspend/Fine the provider's license (EMTs and the sending facility nurse that signed off on the transfer), dissallow any principal or owner of a company found committing fraud from ever being a principal or owner in another company receiving Federal funding (OIG tries to do this somewhat), Suspend/Fine the billing companies involved. This will reduce the number of companies while raising the quality standard (as everyone involved will have more skin in the game and will demand a higher standard). IF medical director's and sending facilities were equally fined for the activies of services they are contracted with, they would be more discriminate about the services they choose to use/align with. This can also be used bi-directionally. I know that our contract with our medical director ends with a 30 day window (to find a new MD) if our current MD is sanctioned for fraud or negligence. There are also a few facilities which don't meet our standard of patient care and we won't do business with them. I understand that alot of ambulance services can't afford to do business as discriminating as I do, but they need to start showing some discrimination in regards to qualities of care.

The current system is still evolving and is starting to get better about detecting fraud versus error, but has a long way to go. I know that my company has a strict compliance policy that terminates any employees whom commit fraud and all of those that fail to report fraud as well. We also do a day during orientation training on just Federal funding programs (Medicare, Medicaid, etc) and business ethics. Our contracts with MDs, facilities and other agencies require that they have a similiar compliance program/plan and training in place as well (alot don't and we won't do business with them unless they do). You would be amazed at how many facilities give my contract people or myself a blank stare when I start talking about having a complete compliance program vs. just replying to mail from Medicare as needed.

In regards specifically to Houston. There needs to be more coordination between the regulating bodies (OIG, State, Cities) to reduce the redundancy and costs involved in this redundancy. Why are my trucks inspected by the State and then the city if they are looking at the same things? Have one regulating body inspect certain elements of a company and assign other regulating bodies to inspect other things. i.e. The state inspects my trucks upon authorization, the city then inspects compliance to local policies/procedures. This would allow for better oversight without paying to "reinvent the wheel" so to speak. 

There is also little coordination between different levels in the healthcare continuum and is a core requirement to allow any form of self-policing. Ambulance service accrediting agencies can self-police only if other healthcare agencies are on the same page (i.e. only use services that have been accredited). However, if Houston were to simply demand that any services functioning in the city limits be accredited (accrediting body/rules/etc TBD by the city EMS department), this would free up their resources to focus on any other specific elements of compliance they wish to enforce/emplace.


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## JPINFV (Oct 23, 2011)

AlphaButch said:


> The problem involves accountability. If an ambulance service is investigated and found committing fraud, _everyone_ involved in that fraudulent act should be held accountable. Suspend/Fine the MD's license (both the service medical director's and the sending MD), Suspend/Fine the provider's license (EMTs and the sending facility nurse that signed off on the transfer), dissallow any principal or owner of a company found committing fraud from ever being a principal or owner in another company receiving Federal funding (OIG tries to do this somewhat), Suspend/Fine the billing companies involved.



Wait, so if I'm discharging a patient from the ED and the secretary sets the transport up wrong or the company does some sort of shenanigans without my knowledge, you want to hold me responsible?

If I'm doing a transport, and I appropriately document what happens, but my company commits fraud, you want to hold me accountable?

If I'm the medical director and not reviewing billing (because I'm not the billing director), and everything I see is appropriately done, because another entity in the company does something shady, you want to go after my license? 

Yea, sorry, but that's wrong on so many levels that it isn't even funny. Oh, and since we want to spread accountablity to everyone involved, regardless of culpability, if any of your patients ever has an adverse outcome, I hope to see you in court until the end. Oh, the malpractice occurred days after you completed the transport? Sorry, you're involved in the patients care and should have known better than not to hand off the patient to that facility. If culpability be damned, let's go full bore and apply it to everyone for everything. 

Somehow I think you'd call foul if you or one of your providers are hauled into court for a malpractice case that they had no culpability with, and aren't immediately dismissed from the suit.


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## AlphaButch (Oct 23, 2011)

If you are a participant in a _fraudulant act._



JPINFV said:


> Wait, so if I'm discharging a patient from the ED and the secretary sets the transport up wrong or the company does some sort of shenanigans without my knowledge, you want to hold me responsible? Discharging isn't wrong, signing that the patient requires discharge via ambulance transportation when they don't - IS.
> 
> If I'm doing a transport, and I appropriately document what happens, but my company commits fraud, you want to hold me accountable? The fraudulent act would occur with the billing service in this case. A better example would be if you witnessed your partner document something fraudulently, then YES, I would consider you culpable if you failed to act/report appropriately.
> 
> ...



I think you missed or misunderstood the sentence - "If an ambulance service is investigated and found committing fraud, everyone involved in that fraudulent act should be held accountable." I'll clean it up some, 

"If an ambulance service is investigated and found committing fraud, everyone actively involved (or allowing such activity to occur unreported with knowledge of said fraud) in a fraudulent act should be held accountable."


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## JPINFV (Oct 23, 2011)

So basically we're moving away from "_everyone_ involved in that fraudulent act should be held accountable, and suspend, fire, fine everyone" to culpability, which makes the sentence following that irrelevant. 




> Discussing Fraud, not Malpractice.



Irrelevant. A crime is a crime, and either the important thing is "everyone involved" or culpability. Fraud in this situation is simply documentation malpractice.


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## AlphaButch (Oct 23, 2011)

Just want to keep the thread as focused on the specific topic area.

The current system has proven itself inadequate. 

This years push by CMS towards better monitoring and reporting systems being implemented by auditors will hopefully help, but it's simply a control measure and doesn't address prevention or punishment.

What can we do to address prevention? or should this even be addressed?

What can we do to address punishment? or should this even be addressed?


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## Martyn (Oct 23, 2011)

If you ask me (and yeah, I know no one did) it just about sums up medical care in the USA...MONEY MONEY MONEY!!!


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## JPINFV (Oct 23, 2011)

Martyn said:


> If you ask me (and yeah, I know no one did) it just about sums up medical care in the USA...MONEY MONEY MONEY!!!




So?


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## Tigger (Oct 24, 2011)

Martyn said:


> If you ask me (and yeah, I know no one did) it just about sums up medical care in the USA...MONEY MONEY MONEY!!!



As opposed to what exactly? Even socialized healthcare is completely wrapped around money, it just comes from more/different sources. Healthcare costs money, no matter the delivery method, much like every other service provided on this planet.


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