- Pregnancy
- Baby & Toddler
- Parents
- Getting Pregnant
- Baby Names
- Product Reviews
-
Registry
- Community
-
More
Want a personalized experience?
Download the free app
2nd Trimester
MrsTotty
member
The Mouse ~ 06.12.08 | The Froggy ~ 02.23.11
My OB's office is being sued.
MrsTotty
member
Read this article :
https://www.wfaa.com/news/health/Grapevine-doctor-defends-using-bargain-IUDs-105496683.html
This was all over the news last night ... and it's MY OB's office (although the OB pictured is not who I see, she is one of 6 in the practice).
I am so torn about this. I absolutely LOVE my doctor. She's amazing, and sweet, and funny ... and I absolutely trust her judgement. But this just seems SHADY to me. I wanted to believe that this was a supplier's issue, and the doctors had no idea, but it doesn't seem to be that way. And even if an American Mirena IS the same as a Canadian Mirena ... the fact that they charged patients (I have a friend whose insurance did not cover it and who was charged full price out of pocket) and insurance companies the full 'American' price is just downright fraudulent IMO.
Also - so now my doctor has a law-suit from the Texas Attorney General's office pending against her. Does anyone know if this type of thing will effect my treatment or insurance/coverage in anyway? I really don't want to change doctors half way into my pregnancy, but I also don't want to get a bill in April and BCBS say something like, 'sorry, your birth isn't covered since you're seeing a corrupt OB' ... ya know? .
https://www.wfaa.com/news/health/Grapevine-doctor-defends-using-bargain-IUDs-105496683.html
This was all over the news last night ... and it's MY OB's office (although the OB pictured is not who I see, she is one of 6 in the practice).
I am so torn about this. I absolutely LOVE my doctor. She's amazing, and sweet, and funny ... and I absolutely trust her judgement. But this just seems SHADY to me. I wanted to believe that this was a supplier's issue, and the doctors had no idea, but it doesn't seem to be that way. And even if an American Mirena IS the same as a Canadian Mirena ... the fact that they charged patients (I have a friend whose insurance did not cover it and who was charged full price out of pocket) and insurance companies the full 'American' price is just downright fraudulent IMO.
Also - so now my doctor has a law-suit from the Texas Attorney General's office pending against her. Does anyone know if this type of thing will effect my treatment or insurance/coverage in anyway? I really don't want to change doctors half way into my pregnancy, but I also don't want to get a bill in April and BCBS say something like, 'sorry, your birth isn't covered since you're seeing a corrupt OB' ... ya know? .
The Mouse ~ 06.12.08 | The Froggy ~ 02.23.11
This discussion has been closed.
Re: My OB's office is being sued.
The Mouse ~ 06.12.08 | The Froggy ~ 02.23.11
I doubt it would effect your care, and I'm sure this case will take well over a year, if not years, to litigate. You should be long gone from them by then.
The fact is, more doctors do this than anyone thinks, but this doctor opened her trap and now the spotlight is on her.
They may be put up for review but they won't likely lose any kind of licensing over it. And if they did, it wouldn't be for a good while.
That's silly. The office manager is the one that probably made the decision, and chances are the doctors don't know the legality of what happened. They practice medicine. They don't do billing. If you have a qualified doctor that you like, leaving them because of the office manager's crappy choices is foolish.
Hell, in my first OB office, that I left at 18 weeks and went to where I am now, I told the doctor about problems I had with the staff and he said he couldn't do anything about it because he's actually an employee of the practice and he just does the medical part. he doesn't control anything in the front offices.
The OB probably didn't realize it would be an issue or I'm sure she wouldn't have opened her mouth.
Do I see the ethical question here? Absolutely. Do I think that this is fraud? No. on a personal level. On a legal level, only the outcome of the trial will tell that.
I have been in a position where insurance didn't cover BC and buying from Canada for the exact same product was much, much cheaper. It was the exact same thing but without all of the healthcare price-mark ups required in the US. It was legal back then (as far as I know), though I do not know the current legality of it.
To me, as long as they followed the law and were providing the exact same product, I think that they were being savvy shoppers and were in no way compromising the health of patients. Also, if the insurance requires them to bill a certain amount--and they did--I also don't see a problem with that. What the insurance requires is a question for the lawyers, though.
Personally, I would not leave a practice over just this one issue.
More Green For Less Green
Interesting. Being from Canada I've read a lot about how our drugs get into your system by the shady medical important process. I love reading about "black market Canadian drugs"- especially when a lot of them are made in the same US plant.
I would contact your insurance provider as well as the lawyers working on the case. I would simply ask them how this affects other drs in the practice and if this is going to wind up affecting you in the short time you have left there. I would rather be safe than sorry, as it would be an even larger hassle to have to find on OB closer to your due date. Better to be safe than sorry- especially if it means that it's going to cost you a lot of money or be a larger inconvenience in the long run.
I'm just lurking here, but...
This is actually a fairly common practice. There is a group in my area that also was found to be doing this and in the investigation, it was found that many offices do the same thing.
I work for a medical liability insurance company. MOST doctors have, at the very least, had claims made against them. Many others have been sued. It absolutely will not affect the care you receive or your insurance. I wouldn't switch based on this.
Hm, I don't know. There are two sides to every story. They clearly believed (and still do) that the product is of the same quality. Did your friend receive one of the IUDs purchased for less? If so, she should be upset. They were billing the insurance company for the standard procedure at the standard rate. This just felt like a law suit where the patient and lawyer wanted to make some extra money. She wasn't harmed and received the same quality of treatment, you know.
I would ask your doctor about this lawsuit and how it may impact your treatment. I would also call your insurance company.
Bottom line, if you like your doctor and feel you're getting good treatment, then I would stay. If this case makes you feel less confident in the care and treatment, then go elsewhere.
Eh, I don't think it is a big deal, honestly. I wouldn't get an IUD from them, but tons of people go to Canada to get their Rx all the time. There are buses here you can take just to do that because it is so much cheaper.
As far as the lawsuit, I wouldn't worry about it unless she is found liable for something and, even then, it would really depend on the situation. Doctors get sued all the time. I would only be concerned with a pattern or long history of negligence issue.
Ok, I work for the AG's office in Texas and I can shed some light as to what's happening. It's healthcare fraud plain and simple. When you buy something like a generic name product and charge for the name brand because of the cost difference and bill for the more expensive product saying that was provided and it wasn't it's called upcoding and it's fraud.
One scheme is the upcoding and another is billing for services not provided.
It's being done in doctor's offices all over the nation. It's easy to do and it pays out like a slot machine. Insurance companies have contracts with doctors offices as to what procedure code or product will be paid for at a certain reduced price. If they are purposely using the more expensive code to obtain more money for something that essentially costs less than they are wrong and should have used the cheaper code. This will not impact your insurance covereage or which OB you choose to see unless your OB loses her license. If you want to keep your OB, that's cool. What should happen if this happened to you is your insurance should be reimbursed from the company that did the upcoding. You should not be penalized at all.
The doctor's say they have no idea but the doctors are the ones who enter in the patient's file what is to be billed for each visit, each time lab work is done, each time ultrasounds are ordered. The files require doctor's approval which would mean a doctor would review the file to be submitted for payment. Those files then go to an office where it is submitted to an insurance company. The clerks don't determine themselves what is billed, it's based on what the doctor ordered.
You basically have to understand one thing:
Healthcare is a business. A very lucrative business.
Competition exists even in medicine, and actually more than most industries. Any company out there will find the lowest price item they can buy and charge the most markup they can for it. It's called profit.
Why is it that when a doctor uses an identical product that poses no risk to the patient and makes a few dollars, it's lynch-worthy?
Wow, I agree with Emjay!
If you look into the background of many doctors almost all of them have had a lawsuit against them. Have you ever asked a doctor how much of his salary goes towards malpractice insurance? It is a TON! I don't see this being a huge issue.
Do you remember the story about the ob/gyn (or so he claimed) operating out of a U-Haul storage center? Now that is a situation where you should switch doctors.
I would change doctors, only because I wouldn't want my money supporting this type of activity.
I'm so sorry. I know how hard it is to find doctors that you trust and get along with.
Do people have any ethical standards anymore? It's lying, plain and simple. While I don't see it as lynch-worthy, I also don't agree with it and wouldn't support a business that I KNOW is participating in unethical activities.
It's thinking like this that reminds me why our nation is in it's current crisis. No one has any conviction or stands for anything true anymore.
Fraud is fraud and it is never right IMO.
ETA - There are also differences in the formulations of generics and the name brand drugs. While some people don't see a huge issue with this, as someone living with Crohn's Disease, who has had to try multiple drugs in order to find the one that will work for me, I see a big problem. The slightest change in a drug could cause problems for people with conditions like mine.
Because it is fraud and unethical. As a minimum standard of care, a patient should be informed that the product she thinks she is getting is, in fact, the one she is getting.
I don't care if people personally make a decision to get their generic prescriptions from Canada. But, if I want and pay for one thing and I am given another without my knowledge, that is wrong. And I'd be livid if I was one of those women who received a letter that an unapproved product was implanted in my body without my consent.
I just feel bad for my friend, because she doesn't honestly know whether she has an illegal Canadian device, or an American device. And even if they are identical, she paid the American price out of pocket for it. Almost $1,000.
As an insurance adjuster, I absolutely recognize this as billing fraud. I see it EVERY DAY on invoices that I receive ... on a much smaller basis obviously ... and it pisses me off. That being said, I have never received anything but wonderful care from this practice ... and I'm really hesitant to leave them and shoot myself in the foot.
The Mouse ~ 06.12.08 | The Froggy ~ 02.23.11
It's very hard to find an OB that is wonderful. I don't envy the position you are in. I feel bad for your friend as well. Did they chart the serial number from the product to determine it's origin? I'd be mad too if I paid a slew of money out of pocket for a bargain price product that was put inside me.
If they said "You are getting a product that was manufactured in the US", fine. Fraud.
If they just didn't tell you, and you didn't ask either, what's the big deal?
I'm quite sure that Bayer Healthcare, the company that manufactures Mirena, holds both countries to the same standards. I don't think they set up shop in some guys dirty basement, and make the IUDd's on the same tables as they eat dinner on.
If it was some unknown company churning out IUDs and they sold those as Mirena, that's a big problem. But it's still Mirena, it still works the same, it still came from Bayer, so what's the problem?
Her insurance would have paid the same price for the Mirena from the US, so what is the big deal? And the ones that got the Candian IUD's got a discount, so they should all just relax.
She didn't get a generic. She got the same brand, from the same company, just in their Canadian branch.
LOL
This is still up for debate. They bought 500 and only sent out 40 letters. My friend got hers 2 years ago, before they received the letter from the FDA and before they stopped doing this ... and she paid the full price out of pocket. So how does she KNOW she didn't get the Canadian version, and then was charged for the American?
The Mouse ~ 06.12.08 | The Froggy ~ 02.23.11
When a product is implanted in you, they have to document the product brand, the lot number, and the date. This is so if there is a recall they know who to contact.
In her chart there should be documentation of it. Either hand written or some companies provide a little label to peel off and stick in your chart. She should be able to request copies or to at least go in and look at her chart.
I know eh? The reality is the Canadian system requires drugs to be tested longer than the FDA does. That's why Canadians will often try to head to the US to get drugs which are still being considered "experimental" in Canada. If you can get it up here, it usually means that it is pretty standard medicine. What sucks about this situation though is there are a lot of Americans who are travelling North to buy drugs or set up residency here for six months so they can get free surgeries. It abuses our system and weakens yours. My mum had a massive heart surgery a few years ago and half of the people in the recovery room were "ex-Americans" that moved to Victoria to get heart surgeries from the Royal Jubilee center. The shity part is after talking to a bunch of them, they were openly admitting that they only moved for the medical care and would be moving back now that they'd had the surgery. If you move here because you want to emigrate and use the system because you need it then awesome, that?s what it?s here for. But to openly admit to abusing our system while still in our hospital, that?s just douchey. I?m not in any way saying that all Americans are out to get Canadian drugs, but it is happening and it really is abusing/negatively affecting both of our health care systems.
My doctor must use the canadian ones because she told me it would only cost about 300.
I don't care.
The office obviously wasn't completely honest, but if they don't cause any harm I don't personally care. That's just me though. I would not judge someone for wanting to switch offices.
Meh- there's as many Canadians willing to drive down to Buffalo or Detroit to pay out of pocket for an MRI that they can book within the week rather than 6 months from now.
I believe in this case it's wrong because it wasn't just business, they were actually LYING.
Make a pregnancy ticker
This pretty much. I think the only shady thing about this would be charging patients (especially those without insurance or who are struggling financially) full price for this. I realize this is not going to be a popular opinion, but that's fine with me.
They are all made in the same place...of COURSE the company that makes them is going to say that you shouldn't buy them elsewhere cheaper....bc they are losing money on the deal. Its amazing though, you can actually walk into a pharmacy in Europe and just purchase an IUD without a prescription for much less than they charge in the US for them.
OB-GYNs are constantly being screwed by insurance companies (they bill $200 for something and the insurance company says that they will pay $40 for it) and health care laws and so if they can find a way to save money - by purchasing the exact same product for hundreds of $$ less, and then passing those savings onto their patients....well....I don't necessarily see anything wrong with this and I suspect it happens quite frequently. If this is a practice that you trust and have trusted for a long time and have received quality care from in the past, I would take this with a grain of salt...this will not affect your care.
A