| Shake That Brain!® Solutions
Volume 3, Issue 7 |
| IN THIS ISSUE: 1. "Hard to Say" & "It Depends" (ASSURANCES
FROM THE GREY ZONE) And now, on with our newsletter ... In last week's issue ("Fraud Hotlines, Customer Service & a Complete Disconnect ")I wrote about my frustrations in trying to report insurance fraud (on the part of my chiropractor) to my insurance company. Finally, after 9 days and 6 attempts to contact their Fraud Hotline, I got Inspector Stonewall to pick-up-the-phone and call me back. The first few minutes of the call involved my venting about poor customer service and Stonewall's denying there was a problem. (I was reminded of a Lenny Bruce line: "Even if you're caught in the act - even if you're caught with your pants down around your knees – deny it, say it isn't so.") Segueing to the real business at hand, I tossed out a softball – something easy, just to get things started. "Over billing. That's fraud, right?" "Hard to say." "It's 'hard to say' if over billing is fraud?!" "It all depends." "On what?" "On lots of things." "Such as?" "Lots of things." "Okay, let me give you a hypothetical." "I don't deal in hypotheticals. I deal in facts." "Okay, here's a fact: My chiropractor billed me X but submitted a claim to you for 4 times that amount. Is that fraud?" "I'd have to know all the facts." This Kafkaesque exchange went on like this for another ten minutes. Finally, I asked: "Is there someone I can speak to who might know a little more about this?" And so – with much relief, I imagine – Inspector Stonewall gave me the phone number for Dr. Big, Medical Director of the insurance company's chiropractic consulting company. "May I tell him Inspector Stonewall suggested I call?" "Be my guest." And so - 8 days and 4 phone calls later - including a call to Stonewall informing him that Big wasn't big on returning his calls, either – Big called me back. The wait was worth it. Big was better. A lot better. "Of course it's fraud! How could anyone say otherwise?" That's what I'd been wondering. "What about this pre-payment plan I signed up for?," I asked. "Twenty-five visits for $25 each? Is that kosher?" "It's quasi-legal and a direct violation of the State Chiropractic Board." "And does anyone ever go after these cases? For over billing or these pre-payment plans?" "These sorts of violations are really too small for an insurance company to worry about. They worry about the big time stuff." "And the State Board?" "They don't have the manpower either." "And if a cranky consumer, such as myself, blows the whistle? Then what?" "Best case scenario? They'd make him resubmit his billing and return any money he owes to the insurance company." Trying put things in perspective, I asked: "So it's like: You rob a bank, someone catches you, and – as a penalty – you have to return the money?" "That's pretty much it." So there you go! I finally figured it out: The reason it took me 17 days, 7 phone calls and 3 faxes to get a straight answer is because the answer is: No one cares. For the insurance company and the State Board it's not an ethical or legal question; it's a business question: "Are we in the business of cracking down on over billing by sole practitioners?" Apparently, the answer is: "No. We're in the business of trying to hook BIG FISH only." The little guys – like my chiropractor and yours – are free to steal with impunity. And they know it. Don't believe me? Here's part of e-mail I received last week from one of my newsletter subscribers. She writes: "Years ago, I turned in my boss, a surgeon, for Medicare, Medicaid, Blue Cross and Blue Shield insurance billing, thereby wrecking my own lucrative career as his office billing manager, and probably not damaging his much." But first, she explains: "I sat down and had a serious talk with my Dr. Greedy. He told me (expecting me to accept it): 'If we're caught, I only have to pay back the over-payments. They'd have to prove fraud, not just mistakes to levy any penalties. Meanwhile, I'd have made interest on the money anyway. So I still win!'" Any questions? ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ "Whistle Blowing: Daring or Duty?" Meanwhile, for more information on making sound ethical business decisions, see my 2-page guideline sheet, "What Should I Do?" Click on: http://www.shakethatbrain.com/stb-ethics.What%20Should%20I%20do.TIP%20SHEET%20VERSION.html Also, here's a link to recent "Shake That Brain!" PR from the San Diego Union Tribune: http://www.signonsandiego.com/uniontrib/20060507/news_lz1v07shelf.html And remember: "In times of deceit, telling the truth is a revolutionary act." - George Orwell --------------------------------------------------------------------------- BOOK DISCOUNT: To get your HARD COVER COPY of "Shake That Brain!" for
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from AudioTech at: While this is an EDITED VERSION of the book, it still packs a WALLOP. PRIZE AHEAD! -------------------------------------------------------------------------- This newsletter has been brought to you by Joel Saltzman (dubbed "Crazy like a fox" by the Chicago Tribune). Joel is a speaker, facilitator, consultant, and creator of the "Shake That Brain!" system - for innovative solutions and transformative thinking. TO SUBSCRIBE: If this newsletter has been forwarded
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