Concerning the best strategy for dealing with an investigator whether it is from the insurance industry or the local D.A., most doctors will not have intimate knowledge and experience of dealing with the fine points of the rules and law. DJ Osborne suggests that a doctor rely on creating goodwill. By the time the insurance or D.A. investigator shows up at a doctor’s office, the most likely scenario is that the target has already been painted squarely on that doctor’s back. Trying to negotiate this mine field without proper defensive skills can easily lead to greater peril.
I always played straight down the middle when it came to insurance billing and when dealing with patients and their financial issues. Therefore I was completely taken by surprise to find my office full of people with badges and guns one day a few years ago. Since I was sure that I had done nothing wrong I figured I could explain the mistake and it would all go away. I didn’t realize that everything I said was going to be twisted to suit the job advancement opportunities of the investigator and had little or nothing to do with truth or fact finding. I was properly advised to quit talking and make them prove through legal channels that I had done something inappropriate.
What did I learn?
I had been using an electronic chart-noting system so my records were coherent and legible. Ultimately this helped make it difficult to make a case against me because those records were so clear and treatment dates, type of service and billing all matched. Had I been relying on hand-written notes, I am sure the investigation would not have gone away so easily.
Find the best lawyer you can and let him or her do the talking. A friend recommended an attorney who was very experienced with insurance and state board issues and I paid about $45,000 over three years. I consider this money well spent to have the issue go away with no charges ultimately being filed.
The system will be very impersonal and, like I said, needs to be fed. To avoid being prey, you can’t look like prey. That doesn’t mean a person needs to be rude, but politely let them know that this will not be easy for them and that, if they want to make a case, they are going to have to work for it.
Daniel Schlenger, DC
January 26, 2009