Spillin Tea Across America: Maryland

[00:00:00] Welcome back to Credentialing Chronicles, where we spill the tea on the doctors you see. And we're spilling it baby all across America. How's everybody doing today? How are you Nyleen most importantly?

[00:00:29] I'm doing fantastic. Actually, I think I might be coming down with something, but you know, spilling it through like regular MSPs, you know how we do, never get a day off. You drink a little hot tea and you keep it moving, right? Yes, yes. Take your day quill and just keep going, keep going, keep going. Well, I guess I should say, you know, before we pour today's tea, my lovely sexy co-host, we want to make one thing crystal clear, right? That neither Credentialing Chronicles, Nyleen

[00:00:57] Flores, Shannon Gray is a YO nor any organization affiliated with this podcast, y'all. Okay, this one right here has credential privilege enrolled, employed. Oh, Lord, Nyleen went crazy with this one, y'all. I don't want to get in trouble because you know, we be spilling some tea. All right, we need to start with our disclaimer on this one. Sometimes we be forgetting that's

[00:01:23] a word disclaimer. Nyleen, what are we going to say about these people? Okay. I mean, it's the disclaimer still going on y'all or otherwise vetted any of the providers, facilities, or y'all the individuals that we discussed in this episode. Okay. But I'm gonna let y'all know all the information

[00:01:47] discussed today. You know, we derive it from like publicly available court records. Number one, government reports, disciplinary actions, our hotline, you know, we got the text now, hotline, credit line. Okay. So we get some juice on there. All right. Regulatory findings and then news

[00:02:12] publications. So, you know, really the purpose, you know, of our show, right, Nyleen, like the credentialing of the Chronicles, right, is to be educational and to focus on healthcare governance, credentialing, patient safety, all of that. But truly, as always, for the public to kind of

[00:02:35] understand what we do as MSPs and what they can do on their own, because the receipts are public, baby, right? Yes, exactly. And I just love that we try to do it in a fun, educational kind of way. We don't want to bash anybody. We don't want to talk bad about anybody. We really want to be educational, but we just don't want to be like the boring blah, blah, blah podcast. You know what I mean? We're not blonde. You're not blah, blah. Exactly. So today we're going to head

[00:03:04] to the state, which is famous for some blue crabs, waterfront views, and apparently, girl, enough healthcare drama to keep our friends in Dateline employed for decades. Okay. Okay. Dateline or credentialing Chronicles, honey, because we out here reporting. I mean, live, live, live. No, no, no, we're not live. Not until NAMS, right? We're about to be live

[00:03:31] in NAMS. That's going to be so much fun. Are you going, Nyleen? Are you going? You got your outfits picked out? Oh, I sure do, Shay. Yeah. We can't wait to tell y'all. Okay. Anyway, Marilyn understood the assignment when we was asking for crime, fraud, all of the tea, right? Yeah. Well, Marilyn obviously didn't just bring the tea. Marilyn brought, girl, an industrial-sized tea kettle at this one. Oh, Lord. Not a tea kettle. Okay. So you mean the kind they use in like

[00:04:00] hospital cafeterias, they just poured it out? Yeah, yeah, yeah. Like the cake size, the cake size, that. Well, we're going to talk about fraud, dangerous medical practices, regulatory failures, and one story that is so weird that if it were like a Netflix script, we'd accuse the writers of like maybe they just did do much. But it's not real. Yeah. Grab your tea, guys. Let's get into it.

[00:04:27] Okay. So we're going to talk about, let's bring it back to 2020, which I can't even believe that I'm telling you this is six years ago. I can't believe it. Isn't that crazy? It's crazy, Dylene. Yes. So our first story begins during one of the most chaotic periods in modern healthcare history, which is COVID, right? Fear was everywhere. Testing centers were popping up overnight.

[00:04:52] Federal money, federal money was just like being thrown at healthcare clinics and people were trying to grab it and use it as quickly as possible. According to federal prosecutors, one Maryland physician allegedly saw something besides just a public health crisis. He saw an opportunity. Hmm. Never a good sign. You say never a good sign when you see an opportunity, right?

[00:05:18] Hmm. Well, according to the U S department of justice, a, this doctor was girl, he was convicted by a federal jury because you know, there's doctor crimes that just stay in the local courts, but like there's doctor crimes that go all the way to like federal. It's cross law state lines, the wiretap

[00:05:40] the wire fraud. If he was traveling in a car, in a train, in a plane, all of that. Right. Cause then you, you fraud, then you, the federal side. I'm not a lawyer though. No, not a lawyer. This is not legal advice. So disclaimer, baby, cause you know, we'd be getting into it. Okay. So this doctor took advantage

[00:06:07] of this COVID-19 situation. As we heard so many doctors do girl, prosecutors alleged that more than $15 million in false claims were submitted. Do all they were submitted to Medicare and other insurers, because apparently he was given office visits to everybody that never actually happened and weren't even medically justified in connection to this COVID testing site. So

[00:06:35] full office visits. I don't know for COVID tests for people, for people. Oh my. So the people were coming in and he was swabbing them or he wasn't swabbing them and he was charging them. Which one was, which one was it? All of that. Well, exactly. He, he, they were coming in just for COVID tests and they were saying that they had a full office visit. So he was like over billing. Oh, okay. Right. Okay.

[00:07:05] Like you can't do your annual exam and come in for COVID and come in for a breast exam and come in for your, you can't, you know what I mean? Yeah. Yeah. I got you. Yeah. Right. Right. So what happened is according to the prosecutors, the patients often arrived simply seeking testing. So I came in for one thing. I came in because I want to get tested for COVID. Everybody. I have a little sore throat. I can't say. Yes. I remember. Exactly. Exactly. But what happened is when the super bills

[00:07:32] went out, when the billing actually happened, they submitted a little bit of a different picture, which was a little bit more expensive picture of what was happening in the exam room. So you up charging, you, you, you, you, you, you. Correct. You adding more to the bill is what you're correct. Correct. Correct. Okay. And I mean, really, you know, you know, I mean, I, I, for the MS,

[00:07:55] for the patients, can y'all believe it? Oh my God. And then for the MSPs, you know, a lot of people think once we get the person credentialed, we done, we're done for two years, we're done for three years. Right. And it's not about that. You guys, because when you're doing your OPPE, I'm down with OPPE. I'm down with OPPE. Okay. So that, that is your ongoing

[00:08:21] performance. What is it? Performance improvement. Right. Performance practice evaluation. And then the FPPE. Okay. But that's when you find something, you go a little deeper, but anyway, the monitoring matters because you might want to think, let's get some billing records in there. Let's not a bad idea. Right. We asked for, for case locks, but do we ask for billing records?

[00:08:47] It's kind of interesting, right? Right. A random eight months of your billing records in the last two years. And you could see, does he bill out for 55 breast exams? 99 COVID says you can kind of see that pattern. I lean. I'm just saying oversight matters, right? Auditing matters. Nyleen, you know that. Right. Because the clean file doesn't guarantee necessarily that they're being compliant when

[00:09:15] they're doing the stuff, right? It does it mama. And then boom, we have fraud. Well, let's talk about pain management because you know, the fraud runs rampant over there. I mean, we were just releasing a whole bunch of stuff on our social media. I seen the ladies, they was putting some stuff out there about social, about fraud pain clinic. How do you know good pain management doctor? I was thinking,

[00:09:40] Oh, huge, huge pain management. So, because whenever healthcare fraud stories start with the words pain clinic, okay. You know, you immediately know we're heading somewhere. You guys, that's not going to end up good. Right. I mean, people, y'all know, y'all know epidemics have happened with this, right? Yes. Yes. And I've seen all kinds of pain stuff, girl. We've been seeing a lot of it. How many

[00:10:06] have we done on it? We've done so many stories. Yes. Yeah. And all kinds of levels of pain management, not just drug abuse, but all kinds of stuff. Well, in this case, according to federal courts, they summarized some reports regarding Maryland healthcare fraud prosecutors. So it's interesting because it's like a very niche type of person that's doing this. Anyway, they found two doctors operating a

[00:10:35] Maryland pain management clinic who ended up being convicted of another healthcare fraud involving false claims, obstruction, wire fraud, and other offenses connected to clinic operations. They apparently alleged that there were millions and millions of dollars in this fraudulent activity. Millions and millions and millions of dollars in activity. Girl, you know what fascinates me?

[00:11:05] How many people have to ignore the red flags before something like this is reaching a federal jury? Right. Like there's a lot of steps, right? I mean, think about it, not only medical staff offices, but you're talking about all the girls or men and whomever works in the doctor's offices. Like they're seeing what the doctors are writing on these super bills. They're seeing what's being built out. There's compliance teams, there's auditors, there's peer review committees. And at some point

[00:11:33] someone has to know what's actually going down. You know what I'm saying? So do they act is my question. Does anybody say stop? It doesn't look right. Or does everyone assume somebody else already did look at it? Or that's what Dr. So-and-so does all the time. I mean, that's the other thing too. He always bills like that. Well, honey, that's not right. That's not right billing. I mean, you know what I'm saying? Yes. And that's where organizations get into trouble. But you know,

[00:12:01] since we're on the topic of billing, Shannon, I think we have an amazing announcement that we have to make with Credentialing Chronicles. Oh, I'm so excited. Oh my God. I'm so excited. I'm so excited. So I'm just going to go, babe. This episode is sponsored by Nimble, your RCM company of choice.

[00:12:23] For any outpatient who, if you are looking to maximize profits legally and not get into billing fraud, you're going to definitely want to check out, nope, nope. You want to check out Nimble Solutions and then we will tag them on our episode notes and they will be on our website. Please look at them for your billing solutions. I mean, billing, honey, you know, that's, you want to keep your billing

[00:12:51] records straight and Nimble's going to keep them straight for you. They are not playing around. They're not going to walk you into fraud. Okay. And I know we're all dealing with this. Nyleen. And what a cute name. Nimble. Keep it nimble. Keep it nimble. Keep it right. Keep it nimble. Keep it right, Nyleen. Okay. Sorry. Now back to our regular scheduled programming

[00:13:17] sponsored by Nimble. I want to shout out to, cause this is their first episode that we're bringing in. So we went up, bring them in right. We want to let them know that they chose the right podcast to sponsor honey. And when they're with Craig Chronicles, we're going to just love on them and we're going to let everybody know about them, that they are such a great billing software because honey, the fraud is real, is real. And they going to keep you right. You ain't about

[00:13:46] to get no fraud with them. Yes. Yes. They handle everything from coding to compliance to clearing house. Do they do the clearing house? Yes. They clear it. Oh yeah. Come on. Yes. They do all things. Okay. So let's get to story number three, girl, the doctor who thought he knew better than science. So our third story involves a doctor who is disciplinary, disciplinary history became nationally

[00:14:13] known girl. So what do you mean? Like when a medical board starts using phrases like what emergency suspension, honey, you know, that something spicy is about to happen. Yeah. Well, according to the records on this one involving a disciplinary action by the Maryland board of physicians, the doctor's license was suspended after regulators concluded he was using, well, they were, he was using treatment protocols that posed substantial risks that were not evidence-based and involved

[00:14:43] questionable diagnoses and treatment recommendations for vulnerable patients. The board determined that his conduct endangered patients and subsequently upheld disciplinary actions on this doctor. So he was taking advantage of their vulnerabilities and maximizing all kinds of treatment that weren't justified. Honey, Craig Chronicles has determined the conduct endangered the patients. Cause that sounds like it was endangering the patient. I mean, really, you know, one of the

[00:15:12] hardest things for credentialing professionals is balancing the innovation, honey, that be happening everywhere. Okay. With the safety of the patient. Right. Because medicine does change and there's a lot of new procedures, new functional medicine, new techniques, right? New drugs that are out there. But the reality is evidence matters, right? Research matters. Standards matter when we're treating patients,

[00:15:39] we have to make sure that we're treating them. Yeah. Treating them according to the appropriate, I guess, plan that is the safest for the patient. And patients should never really become unwitting, you know, participants in someone's personal experiment or someone's personal journey to, to discover something. And they have no consent in the process. I mean, your consent at a patient,

[00:16:04] as a patient is, is your goal, you know, it's your, your, your, and that's why, and that's why it's always okay to say, I want a second opinion. If your doctor is not doing what they're supposed to, or you don't feel comfortable with the way that that office is running. And you know, I don't want to just put it on the doctors. There's a lot of mid levels right now that are just saying things or you're not doctors or they're new. And sometimes they say that they're going to check

[00:16:30] with the doctor, but they don't. So we want to make sure that you as a patient feel empowered to go and get that second opinion. If something doesn't seem right, if you're not getting better, right? I mean, unfortunately, sorry to interrupt you, even if it costs you something, you know, even if you have to pay a hundred dollars or something for the office visit, because you just don't want to, you know, that a hundred dollars could save your life. That's right. That's right. So what's our last story about?

[00:16:59] So girl, the final story isn't even about one provider. You know, it's about an entire system had a, Oh, everybody's oversight, you know, ain't nobody's everybody looked the other way. Oh, and honestly, those are the stories that scare me the most because sometimes we can keep track of one doctor, but an entire system. I mean, because if one provider fails, patients are harmed, you know what I'm saying? But if oversight fails, then everybody that walks through the door,

[00:17:29] of that facility is at risk. Even the staff. Yes, yes, absolutely. So this story, it was an independent audit that was released by some Maryland officials. Dozens of girl deaths, deaths involving police restraint were allegedly misclassified over many years by the state's medical examiner system. Auditors concluded numerous deaths should have been classified differently and cited concerns regarding documentation,

[00:17:59] review processes and oversight. State leaders subsequently initiated reforms and further investigations. So girl, the Emmys were saying that the patients died of something else instead of what they actually died for, which could have been abuse. Yes, it could have been abuse. It could have been restraints. It could have been all kinds of stuff. Who knows? I mean, that's a reminder, mama.

[00:18:24] Powerful reminder right here. Healthcare isn't only about a physician, a hospital, healthcare relies on systems. I mean, you see hospitals, the system moves into the community, takes up and buys all the hospitals, all the clinics. And then, you know, so if there's a, if there's a, a kink somewhere, you know, you're the patient that's caught up within that system, right? But in reality, but girl, even in death, like even when we die, we got to watch what they

[00:18:54] say about us when we die. Your family, somebody got to have your help out there, babe. Well, that's why systems require accountability. And like, even if you're just checking the dead people, like you got to make sure you as a physician are held accountable for making sure that we tell people that they died the right way. I mean, come on. You shouldn't even have to say those words out of your mouth, Nylee. Like, I mean, you think that's

[00:19:20] implied? I mean, the healthcare industry, you know, again, it depends on the public behaving, but I'm sorry, believing that investigations, reviews, peer review, credentialing, regulatory oversight are all functioning properly and happening regularly. Right. Because that's what we say. You know, we're always talking about how hard MSPs work to ensure that all of these systems and we are holding the physicians and allied health

[00:19:47] accountable. We want to make sure that people know there is a system that exists. Well, I think one thing, to be honest with you, I'm going to say this because I was an MSP in corporate America for a long time. I think they try to silo MSPs. You know what I'm saying? Like for so long, there was privileging. So long, there's contracting. You know, sometimes they wouldn't even be in the same building. They use the exact same information. You know, there's billing. You know, there's contracting. You know what I'm saying? I mean,

[00:20:16] so there's just all of these different areas of monitoring, you know, and they try to silo it into this. But really, everybody should be talking to everybody because they're all reporting on the same physicians and then they're able to spot patterns faster, right? Exactly. Well, before we close, let's talk a little bit about Maryland's transparency because according to the Maryland Board of Physicians, disciplinary actions, licensure information and public board actions, okay,

[00:20:46] are all available on their board resources and on their website. So that's a good thing. They're also available if you use Baton Health, baby. Because if you use the Baton, right, then it takes you directly to the main source. In this case would be Maryland, okay? And then, but not only do you see Maryland, you see all the other license that maybe wasn't disclosed to you.

[00:21:16] So it's a little like the FSMB, but you know, it's a, it's a, it's a privatized one. You know, the FSMB is all like, you know, government. But you know, he, he is just everybody, the nurses, you know, FSMB is only what? Doctors, you know? And so you can really get a good roster going for your people. And again, it, it directs you straight to that board's resource right there. So click on the button, boom, you're on the board. But again, that's Baton.

[00:21:46] That's Baton Health. So what does that mean? BatonHealth.com. What can you do then? What are you telling patients? What do the patients have to do, Shannon? Patients can't use Baton Health, but that's okay. That's okay. He loves y'all too. MSPs can use Baton Health. But patients, y'all have homework. Y'all have some homework to do because there are free resources. They're mandatory to be free, Nailene. MSPs can use the same as a doctor. Yes. Before surgery, before you get treatment,

[00:22:13] before you check a doctor, at the very least, go to the board website. And when y'all search, just go to like your state. In this case, it's Maryland. You're going to put Maryland Board of Physicians, or I want to verify my doctor's license. Tell me where I can verify my doctor's license in Maryland. Take the five minutes, verify the credentials, verify the license. All you need is the first name, last name, you guys. That's it. Yes. And then verify the disciplinary history, you know, on that doctor. It does show up on there.

[00:22:42] A lot of times they show up the board certification information. Sometimes they show up their education information, their training. So, I mean, you can really do a thorough verification, you know? Um, and I was even going to say, Nailene, before you pay your deposit, like if you're going to go get some mommy makeover, before you pay your deposit, verify. Especially if you're going to go there.

[00:23:06] Right? And the med spas that are happening, Nailene. The med spas, everybody's going to jail for the med spas. I mean, trust is important, you guys. But verification is free, and it could save your freaking life. Yeah, absolutely. So, let's end with our PSA, Shannon. So, I'm going to say for patients, we've done a big PSA today. Please look up your doctors, ask your questions, verify board certification, verify at the very least

[00:23:34] that they have an active license, and see if there's any actions on there. Review the public disciplinary actions. And if just something feels off, just ask, you know? If a doctor's office doesn't look like a doctor's office, there's a reason. Say it. Say it. Say it. Say it. Say it. A good provider, you know, welcomes questions. A bad provider hopes you don't ask them. And then they got to add it to if you do ask them, right?

[00:23:57] Yeah. Yeah. Okay. So, for our providers, we love you. M-D-D-O, N-P-P-A-P-C-N-C-R-N-A-D-D-D-S. You know, all y'all out there doing the thing. Your license is not your reputation. Your behavior is. Okay? So, just remember, also, you don't want to make sure who's using your license number, your MPI number. You know, that's sometimes where the fraud kind of lays.

[00:24:25] Mm-hmm. Yep. Maintain your competency and please practice within your scope. That's all I'm going to say. Don't say you can do something and you really can't. I know. Don't go out there, right? Don't go out there. I can do it all. Okay. Go ahead. Who we got next? MSPs. You're not paperwork. You are processors. And look, I think we've touched into something that

[00:24:50] where it might be revolutionizing MSP is because as we bring payer enrollment more under the full MSP scope and not just privileging, I think we're going to eventually take over the billing department. I mean, I'd say, hey, what the heck, you know? We might as well because everything should be monitored and looked at and reported and viewed and analyzed. This is taking over. Yes. Very similar to nurses taking over clinical documentation for an entire

[00:25:17] healthcare system. I think MSPs should just take over. I think we just need to take over. We're going to take over. I'm going to forecast it in 20 years. We're going to be the all experts. As we should be though. You know, there is people out there that are, they do the billing, they do that, you know, they do it all. So they deserve their flowers. If you are that person, comment below. We want to hear from you. Yes. Yes. That is so important.

[00:25:43] It's so important. Every verification that you do, every query that you do, every, you know, peer review for all every discrepancy, every red flag, everything you do matters. And everybody, and the thing is, is this, a lot of our work goes unseen. We work a lot behind the scenes, but every patient does benefit from everything that we do on a daily basis. I think that's why there's more mothers as MSPs, like women, you know what I'm saying? Because,

[00:26:11] you know, they say mothering is a thankless job. Well, so is MSPs. MSP is a thankless job. You know what I'm saying? Like I know now with NAMS, you know, they, they have more recognition, more things, but before it literally was just done down a hall, you know, um, thankless, you know, I mean, and so again, every scandal we've discussed tonight, it reminds us why our roles exist and why they are coming out of that dark hallway. Right. Yep. So Marilyn,

[00:26:41] you gave us some fraud, you gave us some failed oversight, some crazy medical practices, but your board website is pretty cool. So enough lessons to fill an entire compliance conference, maybe. But every one of those stories comes back to the same question, honey, who was paying attention? Because in healthcare, patient safety doesn't begin just in the operating room or just when a patient walks in. It begins long before that, which is when we get the file and we get the application,

[00:27:11] when we do our first verification and definitely with the ongoing oversight that we help provide. Yes. And credentialing gets the providers to the surgery table, but the environment, the culture, the oversight, the caring about the patient, that is what makes sure the patient gets off the table. You guys, that is what it is. And sometimes with, with somebody brave enough to ask one more question,

[00:27:38] does that look right? You know, you got to, right? Yes. So until next time, Shannon. Stay credentialed and not canceled. Ooh, Shannon, that was a lot of tea. Honey, but have they subscribed yet to hear it next week? On all of these platforms, please subscribe, like, and follow us.