4 ms·

How much is the fine for practicing medicine without a license? This is basically what they're doing by denying claims.

ceejayoz 4y ago
They have rubber-stamp clinicians. Here's an ortho doc getting a denial based on the opinion of a surgeon who put a hip replacement in backwards and is no longer allowed to practice surgery, so he works for an insurer now. https://twitter.com/generalorthomd/status/1630349366497095684 https://twitter.com/generalorthomd/status/163034936649709568... https://twitter.com/generalorthomd/status/1632074817607438337 https://twitter.com/generalorthomd/status/163207481760743833...
- Wingman4l7 4y ago
  Yeah, I'm aware of this; IMO it's a loophole they've been heavily abusing. I would deem this "practicing telemedicine". We do have /some/ regulations on telemedicine (I think? I hope?) -- you could argue that they're violating those.
- mindslight 4y ago
  I've been thinking about this, but not enough to dig into the details. Is there a legal obligation for "insurance" companies to use licensed medial professionals for justifying denials (similar to how many fields of engineering require a PE stamp)? And if so, would it be possible to make an organized effort to go after their licenses with the relevant state boards?
  - hypothesis 4y ago
    Those tweets include documents that show doc as restricted to “non-operative office-based medicine or administrative medicine”. Clearly they thought that he is okay in this exact position.
    - mindslight 4y ago
      Well sure, but since he continues to damage people's health even in that limited role, it would seem there is a new cause for action.
      - ceejayoz 4y ago
        Yes; the doc in this case filed a complaint. https://twitter.com/generalorthomd/status/1632074816378507264 https://twitter.com/generalorthomd/status/163207481637850726...
        mindslight 4y ago
        Practicing doctors don't have the bandwidth to do this except in the most egregious of cases though. I'm imagining a non-profit organization that solicits any denial by "insurance" companies, determines if it is based on medical reasons, determines if it is medically imprudent (including harm caused by delaying care), and files a mostly pre-prepared complaint to the appropriate medical board. Make it extremely uncomfortable to work for a death panel. Then if the state boards start really brushing the complaints under the table to protect the death panels, turn it into a direct political issue. Right now there's too much plausible deniability to hide behind.
        Wingman4l7 4y ago
        Sounds like something the "DoNotPay" robo-paperwork-response startup guy Joshua Browder would be interested in implementing: https://twitter.com/donotpay https://twitter.com/donotpay
        wombatpm 4y ago
        Who is now being sued for practicing without a law degree.
        Wingman4l7 4y ago
  - ceejayoz 4y ago
    This doc is licensed. He's just not allowed to touch patients any more. Perfect candidate for an insurance company; he's got no other prospects, so he'll do what he's expected to. Which is deny, deny, deny.

They have rubber-stamp clinicians. Here's an ortho doc getting a denial based on the opinion of a surgeon who put a hip replacement in backwards and is no longer allowed to practice surgery, so he works for an insurer now. https://twitter.com/generalorthomd/status/1630349366497095684 https://twitter.com/generalorthomd/status/163034936649709568... https://twitter.com/generalorthomd/status/1632074817607438337 https://twitter.com/generalorthomd/status/163207481760743833...

Wingman4l7 4y ago
Yeah, I'm aware of this; IMO it's a loophole they've been heavily abusing. I would deem this "practicing telemedicine". We do have /some/ regulations on telemedicine (I think? I hope?) -- you could argue that they're violating those.
mindslight 4y ago
I've been thinking about this, but not enough to dig into the details. Is there a legal obligation for "insurance" companies to use licensed medial professionals for justifying denials (similar to how many fields of engineering require a PE stamp)? And if so, would it be possible to make an organized effort to go after their licenses with the relevant state boards?
- hypothesis 4y ago
  Those tweets include documents that show doc as restricted to “non-operative office-based medicine or administrative medicine”. Clearly they thought that he is okay in this exact position.
  - mindslight 4y ago
    Well sure, but since he continues to damage people's health even in that limited role, it would seem there is a new cause for action.
    - ceejayoz 4y ago
      Yes; the doc in this case filed a complaint. https://twitter.com/generalorthomd/status/1632074816378507264 https://twitter.com/generalorthomd/status/163207481637850726...
      - mindslight 4y ago
        Practicing doctors don't have the bandwidth to do this except in the most egregious of cases though. I'm imagining a non-profit organization that solicits any denial by "insurance" companies, determines if it is based on medical reasons, determines if it is medically imprudent (including harm caused by delaying care), and files a mostly pre-prepared complaint to the appropriate medical board. Make it extremely uncomfortable to work for a death panel. Then if the state boards start really brushing the complaints under the table to protect the death panels, turn it into a direct political issue. Right now there's too much plausible deniability to hide behind.
        Wingman4l7 4y ago
        Sounds like something the "DoNotPay" robo-paperwork-response startup guy Joshua Browder would be interested in implementing: https://twitter.com/donotpay https://twitter.com/donotpay
        wombatpm 4y ago
        Who is now being sued for practicing without a law degree.
        Wingman4l7 4y ago
- ceejayoz 4y ago
  This doc is licensed. He's just not allowed to touch patients any more. Perfect candidate for an insurance company; he's got no other prospects, so he'll do what he's expected to. Which is deny, deny, deny.