I just took over an account from a rep that left and is trying to flip the business. The ASC called to post an MTP fusion and said “it’s Medicare”. I’m finding out this guy was charging under $1k on Medicare/Medicaid and $5k for private insurance. I feel like I’m in a Mexican stand off. If I don’t report this, does he? Then I’m banned. Also, he’s a big golfing buddy with the highest volume doc so I might lose some business anyway.
It's insurance fraud to have different pricing based on a patient's insurance. As a rep you should steer clear of this practice as it will come back to you
This is mild compared to the things that go on under the table on the west side of the state. Above the fold of the newspaper types of things.
is it considered fraud if the doc uses peek implants on Medicare patients when he would usually use bio composite for pts with good insurance?
No that’s not fraud- if he listened to anything you suggest and went through with your dumbass advice; that would be fraud. Geezus Arthrex good luck when you’re finding talent w/ even less $$$.
Dude! Your overthinking this one here. Just get the surgeon whatever he wants for his cases. It’s your job to SELL not to be an insurance narc. This is the kinda talent we have here now in the OR. Bet this kid ain’t even with Arthrex no more. Which to be honest is not a bad thing.
