Earlier this week, I spoke with a colleague who works for a smaller private transfer provider in Houston who is looking at changing jobs. On a side note, there are over 200 private EMS providers in the Houston area. These aren’t 911 services, but rather private transfer operations.
My friend told me about the constant pressure from the current employer to chart things “just so” to make it possible for Medicare, Medicaid, or private insurance to reimburse for the transport. The new company that they interviewed with removed 12-lead EKG cables from their ambulances because “they were tired of them getting lost.” Additionally, this private service says they don’t do a lot of 12-lead EKGs on “routine” transports. Additionally, this employer pays medics who have all of their charts completed correctly early. Medics who don’t have all of their charts in and/or submitted correctly get paid on the “regular” payday instead.
I’ve got two observations from hearing and seeing some of these antics with some (not all, mind you) of the “mom and pop” services out there. The first is that I could have a very nice standard of living suing several of these companies on billing fraud and violations of employment law, particularly the Fair Labor Standards Act.
However, minions, you’ve probably already figured that out. Here’s my heretical thought. Believe it or not, this is a case where bigger is better. Namely, the large EMS companies (AMR, Acadian, Rural Metro, Paramedics Plus, etc.) can’t get away with some of these shenanigans. These companies are simply too large, too visible, and too easy of a target to commit blatant violations of law relating to EMS standards, employment law, and billing integrity/compliance. The potential loss of licenses and/or financial implications would be too large to comprehend. That’s why these companies have at least some form of a QA/QI program, a (presumably) competent human resources department, a compliance program, and perhaps even in-house counsel.
So, the next time your large employer institutes some seemingly inane policy, there might actually be a reason to their rhyme. The policy might even protect both you and your employer. Even if not, I’ve never heard of an Acadian paycheck bouncing. That’s more than I can say for more than one of the small transfer services that pop up like pimples on the face of our healthcare system.
All agencies, be they public, private, or volunteer, have certain degrees of organizational chickenshit.
At least with large agencies like Acadian, you can be fairly certain that the organizational chickenshit is legal, and makes financial sense.
And not only have they never bounced a paycheck, they’ve only failed to give yearly raises twice in their entire 40+ year history.
Perhaps you should write a post exploring the he implications of qui tam provisions of the False Claims Act that would allow a Paramedic or EMT to get a payout for successfully reporting an employer’s fraud.
R,
As a now retired FBI agent who specialized in health care fraud once told me;
Disgruntled employees or ex employees are some of the best sources of new cases.
I think I might mention qui tam in my next documentation lecture. 🙂