Suisun, Fresno-Madera and the AMA

WHILE FILING MY 1996 NEJM, I noticed an interesting letter to the editor. Richard G. Williams, MD, of Suisun, reflects on seeing two lawyers. The first, his own attorney, charges $185 per hour.

By a narrow margin of six votes, delegates at the June AMA meeting approved new ethical guidelines for selling nonprescription, health-related products in a physician's office. Some critics called the guidelines too rigid; others cried that they were too lenient.

Using the report of the Council on Ethical and Judicial Affairs (which called for an almost total ban of such office sales) as a basis for its decisions, the House ended up taking a middle-of-the-road position.

The guidelines for selling the products (such as nutritional supplements, safety devices and skin-care products) include: the physician (1) must validate the product's medical efficacy; (2) offer the products to patients free or at cost; (3) must not participate in distributorships with products available only through doctors' offices; and (4) let their patients know, in full, about their financial arrangements with the manufacturer or supplier and also the availability of similar products elsewhere.

Stephen Grossman, MD, continues a dialogue about "Fraud and Abuse" in the monthly Vital Signs of the Fresno-Madera Medical Society. His previous article was so abrasive that it was relegated to the "Letters to the Editor" page. But there were so many positive responses that he was asked to write "Round Two."

He points out that Janet Reno has made fraud and abuse in health care the number one priority for white-collar crime. Our patients are being tracked through our UPIN number to investigate our bills, labs and DMEs. He points out that most physicians do not fully appreciate that an erroneous statement sent through the US Mail is mail fraud with penalties of $10,000 per line item error.

In one sting, an FBI agent posing as a patient asked a doctor on the way out to sign a form for diapers for the patient's grandmother, who was to become a patient the next week. The FBI returned the next day with guns and badges for charges of failure to do a good faith exam, conspiring to defraud the government (over diapers), and signing a form on a patient who did not exist. Another colleague in Fresno got a $53,000 fine and accepted it rather than fight. Dr. Grossman fears when the new [AMA & HCFA] E & M codes are implemented, "God help us all."

delmeyer@healthcarecom.net            www.delmeyer.net