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Unread 06-09-2012, 07:31 AM   #1
NancyB
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Default Mass. doctor to pay restitution for charging $185 to patients...

http://www.itemlive.com/articles/201...ews/news03.txt

Revere doctor agrees to pay restitution for charging patients a $185 administrative fee
By Staff Reports / The Daily Item

BOSTON — A Revere physician who improperly charged a $185 administrative fee in addition to MassHealth reimbursements for opioid addiction treatment will pay more than $53,000 in restitution, Attorney General Martha Coakley announced Friday in a press release.

"Our office will make sure that access to addiction treatment is not restricted by providers requiring illegal cash payments," Coakley said in a prepared statement. "We are happy that we obtained restitution for those battling drug addiction who were allegedly taken advantage of when they needed help the most."

Dr. Randall Bock was referred to the AG's Medicaid Fraud Division by MassHealth, the state's Medicaid program, for allegations of improperly taking an "administrative fee" of $185 from MassHealth members in addition to MassHealth reimbursement for opioid addiction treatment with the drugs Suboxone and Subutex, according to the press release.

Suboxone is the brand name for the combination of buprenorphine and naloxone, an alternative to methadone that must be administered daily in a federally approved clinic setting. Suboxone was approved by the FDA for office-based treatment of opioid addiction in October 2002.

The demand for Suboxone treatment far exceeds the supply of physicians authorized to prescribe it in Massachusetts. Only about two percent of Massachusetts physicians are authorized, according to the release. As a result, some physicians have taken advantage of this supply-demand imbalance by charging patients cash in addition to MassHealth reimbursement for Suboxone treatment, according to the release.

MassHealth members may only be charged a small co-payment for certain drugs and inpatient hospital stays, the release states.

Physicians are not allowed to charge co-payments to MassHealth members for office visits.

In addition to the financial terms of the settlement, Bock entered into an Assurance of Discontinuance filed Tuesday in Suffolk Superior Court agreeing not to charge an "administrative fee" to MassHealth members or to solicit, charge or receive any money from MassHealth members for any service which is payable by MassHealth, according to the release.

By entering into the settlement agreement, Bock does not admit or deny the Attorney General's or MassHealth's allegations, the release states.

Any MassHealth member who feels that he or she is being charged an illegal co-payment for MassHealth services or goods is urged to call the AG's Medicaid Fraud Complaint Line at 617-963-2360 or use the online Medicaid Fraud Complaint Form.
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Unread 06-09-2012, 10:00 AM   #2
jdjk
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This appears to be good news, but it may be just the opposite. IMO this will lead to a reduction in the already very small number (2%) physicians who already treat opiate addiction/dependency in Massachusetts and any who might have been pondering entering might now decide not too. I am not familiar with that state’s medical system, so I don’t know what their reimbursement rate is but if it is like my state, a one time(?) $185 administrative fee seems far from excessive especially if the physician is accepting insurance.
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Unread 06-09-2012, 11:28 AM   #3
OhioMike
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jdjk, you know I am very thankful for the doctors who take on Suboxone therapy. I am extremely grateful for those (like you) who go beyond merely prescribing a medication and actually try to treat the whole person and the disease! However, “sadly” just here in Columbus I run into too many doctors who #1. Over charge! And who #2. Simple prescribe the medication literally shoving people in and out of appointments, not taking any time with them! …….. IMO, both practices must stop!

Being a bit conservative by nature, I am not one for too much government regulation or interference into the free market. However, there has to be some & it needs to be smartly done and this is a perfect example, how this medication is frankly abused by some doctors! I understand your concern and I realize that could be the result, but in turn with efforts in other places, maybe other more caring doctors can be recruited.

I have been blessed with really good doctors and doctors who place income 2nd to patient care. I like to think that what I learned here over the years helped me in finding such doctors, as I never hired just any doctor and did interview them, so to speak. Nevertheless the difference is huge and because I have frank and open chats with my doctors about this and other problems with treatment, it is interesting to find just how disgusted the good doctors are with the script writers & over chargers!

We have a long way to go in making this treatment more easily available, but, ignoring the wrongs in the process will not make things better, but only open the door to more like them! As quantity of doctors offering this treatment is important, so is quality!

Example:
I have a gal who I began working with 5 years ago. She has done wonderfully with her recovery and her story is one I will share when meeting with others. She went to the cheapest doctor in town knowing he was a script writer. She knew that going in, so we setup her recovery program to compensate for what she would not be receiving from him. Now after 5 years he tells her that he is “forced” to double his fee because of powers outside his control. Oh BULLSHIT, the fact is, he was one of the best known script writers for pain pills who every doctor shopper in the city would go to including me. Now 6 years later he has slowly changed to where he is not writing for the pain pills and only running Suboxone scripts out the door. To compensate for his loss of income, he has decide to hit those trying to better their lives, a fair number of them who got their pain pills from him! He is a general practitioner so he has his practice. When he sees a Suboxone patient he walks in, writes the script and walks out. They spend more time walking from the waiting room to the examination room, than he spends with them and he gets a 100.00 bill for that. Now he wants 200.00 and doesn’t have the guts to tell them why! No agency outside of his office is making him do that! It’s called cashing in!

Mike
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Unread 06-10-2012, 12:12 AM   #4
gotoffmdone
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I see this is GREAT news and its about time the legal profession somewhere got proactive in going after this type of greedy provider. And that is all it is pure and simple greed.

Guys like this need to get out of the business. But what he may start doing is stop taking state insurance only for addiction tx with Sub. He will continue taking it for everything else.

Just like the AG said this greedy asshole was taking advantage of those who needed him at a very low point in their life when they were seeking help. Dr are anything but stupid. The greedy ones know we opiate abusers will do whatever we must to stop wds and reclaim our lives. And if that means paying out the nose in cash for an rx for Sub, thats what we will do. Drs know that and they don't care where the cash comes from, just where its going.

I wish they would let this guy sit in jail for a few days. I noticed his agreement was such that he did not have to admit any wrong doing. Kinda like a no contest plea which basically indicates that if he ended up forcing the AG's hand in court, there would be more than enough evidence to find his little butt guilty.

But we cannot get our hopes up over such a thing. This is not about Sub at all or the practice of treating opiate addicted persons. This is about medicaid fraud. The guy could just stop accepting it for Sub patients and charge out his Sub patients out the wazoo.

My Dr takes TennCare which is Tennessee's name for state medical insurance. But they do not take it for Sub tx. My Dr happens to be a surgeon. He takes it for surgery and post op visits. Just not Sub tx. The guy above should be a little smarter and instead of charging $185 plus whatever he was getting from the state per Sub visit, he should do like the rest of the Drs. He could actually make more money on the backs of folks like us.

wayne

Last edited by gotoffmdone; 06-10-2012 at 12:18 AM..
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Unread 06-10-2012, 12:14 PM   #5
jonella
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Good news. My Dr was in Tennessee she was charging Medicare ( though I paid out of pocket for my appointments) up to 400.00 for the urine screen. I hope they start looking at Dr's outside off Mass too.
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