A couple months ago, I had to choose a new doctor. There was nothing wrong with my old doctor, but my wife got a new job, in a new city, which meant a new insurance plan and the always-befuddling process of selecting a primary care physician.
It's the adult version of pin the tail on the donkey, with the participant stumbling and groping through dozens of online profiles. When you're in the middle of it, it feels like just another menial task, but there's always a nagging feeling that the stakes are a little bit higher. How are you supposed to select the best person to be in charge of your health by scrolling through a stream of faces in white lab coats, smiling back at you from the screen?
I usually pick mine based on location and hope the rest falls into place. It's probably not the best way to do go about it, but I'm not alone in that approach. According to a 2014 survey by the Associated Press-NORC Center for Public Affairs, 88 percent of people say the most important factor in choosing a physician is whether he or she accepts their insurance. Another high-ranking factor: How long it takes to get to the appointment.
Additionally, a doctor who listens and is attentive is far and away the most important factor in what the public perceives as a quality physician. Patients, it seems, are more apt to focus on the personality of the doctor and their relationship than the delivery of care.
Part of that has to do with the fact that as patients, we gravitate toward a physician we feel like we can trust. The other part, of course, is that quality care is still a hard thing to define and judge. Until recently, there wasn't any available information on metrics like infection rates and medical errors. Patients were left to rely, more or less, on their gut. To some degree, that hasn't changed.
All this is to say that given the obstacles inherent in choosing a primary care physician, it can be next to impossible to determine whether that physician is engaged in a massive health insurance fraud scheme.
Take it from Bill McColl, a Yahoo! Finance producer, who found out his doctor was one of the many physicians taking kickbacks from Biodiagnostic Laboratory Services LLC (BLS).
By all accounts, Eugene DeSimone was a competent, respected doctor, McColl wrote in a column for Yahoo! Finance. Over the last year or two, DeSimone seemed distracted at times, but no one suspected he was a criminal, engaged in an illegal kickback scheme in which he was paid $1,500 a month over the course of two-and-a-half years in exchange for blood specimens. The deal netted BLS nearly $1 million, a fraction of the $100 million the company is accused of stealing.
In May, DeSimone was sentenced to 37 months in prison after pleading guilty to his role in the fraud scheme. By then, the shock had barely worn off for McColl and his wife, who found out about their doctor's transgressions through the local paper. McColl pointed out that DeSimone did not project any outward signs of increased wealth. He lived in a nice house, but nothing extravagant, and there certainly weren't any Lamborghinis parked in the driveway. (It should be noted that the owners of BLS didn't maintain the same low profile).
McColl and his wife aren't alone. Another physician, Brett Halper of Glen Head, New York, pleaded guilty in April to taking $5,000 a month from BLS. On the physician review site Vitals, Harper received four out of five stars from patients who described him as a "great doctor" and emphasized the short wait times.
Or take a look at the five physicians arrested in June for their involvement in a different kickback scheme, this one tied to Diagnostic Imaging Affiliates (DIA). As recently as April, Alexander Salerno, accused of taking $130,000 from DIA between 2009 and 2013, is described on Vitals as "confident" and "fast and accurate" with his diagnosis. Another, William Steck, accused of taking $50,000 from DIA, received four-and-a-half stars on ZocDoc. He was criticized for long wait times, but praised for his thoroughness and bedside manner.
The unfortunate truth is that from a patient perspective, there are no telltale signs of fraud and abuse among physicians. However, in the case of kickback schemes like those involving BLS and DIA, a physician's involvement in a large-scale fraud scheme could directly impact patient care if the provider performs unnecessary testing or procedures. In more extreme cases, like the one involving Detroit oncologist Farid Fata, patients unknowingly put their trust in the hands of a doctor who responded with grotesque overtreatment plans.
There are indications that our physician selection process will improve. Just as more publicly released quality care information is paving the way for a more informed patient experience, more physician payment data is allowing us to get peek at how our physicians are making money, and from whom. Each of these pieces will allow patients to make more informed decisions about their care provider.
It will probably take some time for us to scrutinize physicians beyond wait times, location and personality. But as more of these cases come forward, perhaps we'll begin wondering what's really behind that smiling face on the computer screen. Myself included. - Evan (@HealthPayer)