Plastic surgeon Eugene J. Strasser runs into trouble when an angry patient insists he bill Medicare for an elective procedure and he rightly refuses.
Mrs. Lane* was a pleasant woman in her early 70s who I had been seeing for skin cancers over a number of years. Her treatments involved excisions of skin cancers with reconstruction and pathological verification of the diagnosis and clear surgical margins.
All of her operations and healing went well, and she never complained of any shortcomings in her treatments or outcomes. In fact, she was so pleased with all of the results that on one visit she asked me to perform a facelift on her - and she wanted me to bill it to Medicare.
This was not an unusual request and, as usual, I explained that neither Medicare nor any insurance company covered cosmetic surgery. I told her it was not medically indicated, and therefore, deemed unnecessary surgery. She insisted that I do the surgery and “just call it something else” so that Medicare would pay for it. I told her I couldn’t do that. She still insisted. I politely told her that would be fraud, and I could not and would not do what she asked. Although she continued to press me, I finally made it clear to her that “no” was still my answer and it was not a matter for further discussion. She became very angry, stormed out of my office, stopped at the exit, and turned toward me with her finger pointed declaring, “I will get you for this!”
The transformation in this patient’s attitude at this visit was nothing short of shocking. She certainly had not given any indication of this aspect of her personality in all the years I had treated her. However, I had complete confidence in the validity of my treatment of her and considered her outburst an idle threat. I continued seeing my patients and soon forgot about the incident.
Seven months later, a letter from Medicare was a stark reminder of the incident. Mrs. Lane had filed a complaint against me for performing “unnecessary surgery” on her. Of course, this seemed a little ironic because it was unnecessary surgery I refused to perform on her. Medicare demanded a $774.00 refund. I was to send the money back, and then I could appeal the matter.
Knowing my negotiating position with the government, I did as I was instructed. I then proceeded to compile copies of all of Mrs. Lane’s operative and pathology reports verifying the cancers I had removed - all obviously medically necessary operations. I then waited patiently, expecting the matter to be quickly resolved once Medicare reviewed the complete documentation. I was wrong. Months went by and I was still waiting.
Finally I received correspondence from Medicare telling me that they had not made a decision in my case, but that I could request a telephone conference if I wished to pursue the matter. I requested and was granted a telephone conference. I explained to the representative that Mrs. Lane had demanded that I perform a facelift on her under Medicare and how she threatened me for refusing her demand. I pointed out the irony of her complaint and that she had filed a false report. I also went over each operative report with corresponding pathology reports proving each one to be a form of cancer, all medically necessary operations. The Medicare representative indicated complete agreement with my statements and said she had all the information she needed. She said that by law she had 90 days to decide on the disposition of the case. I believed her and felt Mrs. Lane’s attempt to “get” me was finally behind me.
I was wrong again. Months passed. Finally as the 90-day Medicare deadline turned into six months, a total of a year and a half since I first received the Medicare demand for the refund, I received a check from Medicare for $750.00. There was no mention of my $24.00 they kept by mistake or otherwise, but I did not pursue it. The government doesn’t have to explain itself - something well worth remembering in this healthcare reform frenzy. To my knowledge Mrs. Lane suffered no consequences for her actions.
In fact, Medicare enabled Mrs. Lane to “get” me, and I learned that when dealing with the government, no good deed goes unpunished. I guess their policy is indeed to punish good behavior and reward bad. Sometimes it seems no matter how hard I try, I can’t please anyone. I also learned, though, that as long as I did the right thing I could consistently please at least one person - myself.
*Name has been changed.
Eugene J. Strasser, MD, is a board-certified plastic surgeon practicing in Coral Springs, Fla. He is a published author and currently chief of surgery at the Coral Springs Medical Center. He can be reached via firstname.lastname@example.org.
This article originally appeared in the May 2010 issue of Physicians Practice.