Commercial plans continue their audit activity in 2016 demanding many changes and adjustments yet giving little in return. The 2015 audits have not been completed for the majority of substance abuse providers in South Florida, yet the commercial plans have arbitrarily stopped paying new claims even though it takes them at least 6 months to complete a post payment audit. If and when a provider finally gets an audit result, payors are imposing requirements that just are impossible to meet.
Payors do not appear to be paying attention to the public health crisis of substance abuse addiction and the ever growing need for treatment. The assumption is being made by the payors that all providers in this space are over utilizing services and engaged in fraudulent practices, despite the reality that many providers are doing just the contrary. Continue reading →
By now, it’s not news in Florida that drug and alcohol recovery providers are staring devastation in the face as payers continue to mount non-payment offensives. As payers one by one march on the industry and starve providers of cash flow for operations, many providers can be expected to shut down. To make matters worse, as the popular media continues to act as a conduit for gross misrepresentations of industry providers, the public’s affection for the industry can’t be expected to improve. This makes the future look especially bleak for the industry, and yet the silence and stillness of providers is baffling.
Given the breadth of the payer problem (many simply aren’t paying providers), why are we not seeing a slew of lawsuits filed by providers? In nearly 30 years as a Florida healthcare lawyer, I’ve never seen a healthcare sector so hammered by insurance companies. And I’ve never seen it unanswered in court. Continue reading →
I read an article in a local paper the other day. It was about (a) a guy who owned a treatment center (who has not been charged with committing a crime), (b) a lawsuit filed by a large insurance company against a toxicology lab that the insurer owes millions, and (c) the fact that insurance companies pay a lot for toxicology lab testing. I scratched my head, wondering how there was anything newsworthy there. The “story” being sold by the paper, however, created a story with a villain (the providers of services to people in recovery from drug and alcohol addiction) and a “victim” (people receiving care for addiction). I can’t resist responding.
There’s a difference between something that’s interesting and worthy of comment vs. a journalistic attempt to concoct controversy and intrigue that people might buy. There’s not much of the former, but a lot of the latter. People in recovery being victimized by horrible, greedy people is an interesting story. Unfortunately, it’s off the mark and really not helpful to anyone.
There are three pretty safe assumptions we can almost all agree on: first, there are a lot of people who want to live life without active addiction. Second, many of them think they need help to create a better life. Third, some providers of help to people in recovery make a bunch of money providing that service. Continue reading →
When a physician cannot bill for test results, and a company offers to give that physician those test results for free, a Florida Federal Court has ruled that the company is offering the physician prohibited remuneration. On May 5, 2014 the Middle District of Florida granted partial summary judgment on the latest motion in a contentious litigation between Ameritox Ltd. and Millennium Laboratories, Inc. Ameritox and Millennium are competitors and clinical laboratories that screen urine specimens for the presence of drugs.
Millennium provided free point of care testing cups to physicians, who use the cups for initial testing and then return the cups back to Millennium for confirmation tests. Physicians do not bill patients or insurance companies for the point of care tests. Continue reading →