Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
Depending on your age and when you started watching television, you have undoubtedly at least heard of the innovative program "Candid Camera," a viewing staple of the 1960s. This was a television program whose developer and host, Alan Funt, used to say, "Caught people in the act of being themselves." This was television's first use of hidden cameras to film average people reacting to unusual events.
One of my favorite examples featured a very life-like statue in the waiting room of a sham business. Individuals were asked to take a seat in the waiting room prior to their appointment. The statue, a life-size depiction of a man or woman, was placed in the middle of the room for easy viewing by all. As the person waited, the "statue" (in reality, a human white-washed model) would move slightly.
At first, the person in the waiting room would ignore the movements, afterall, a statue doesn't move. But as the movements became more pronounced, the observer became more uncomfortable. Finally, the statue would descend from the pedestal or speak to the startled subject. Sometimes the subject would run out of the room.
The original "Candid Camera" provided hours of entertainment to millions for years before it faded into the rerun graveyard. Occasionally, these early television gems still air.
The health care professions are involved in a similar experience that might be called "Candid Computer." Very simply, computer technology and its enormous data collection capabilities is allowing legislators, government agencies, and third-party payers to more readily view and compare all health care providers. You might say that in terms of how they treat and what they charge, all providers are "caught in the act of being themselves."
Every reimbursement form you fill out, every treatment code you use, every correspondence you produce or receive has been designed to allow third-party payers the ability to quantify and qualify the information into a computer database. Look at the checks you receive for payment from these payers. They aren't hand written anymore, they are printed by a computer.
This data collection process works just like the hidden camera: you don't know it's there, but it records every movement. This technique was used quite effectively in Oregon. Even with erroneous data used by our attackers, the chiropractic profession there was bruised to an extent that will be hard to recover from.
If you think this data is not complete or extensive, think again. I have had the questionable pleasure of viewing computer databases from workers' compensation, Blue Cross/Blue Shield, and others that were well designed. These computer databases were quite effective in revealing those chiropractors who were out-of-step with the billing practices of the rest of the state. They are also easily accessed. Anyone so inclined, could have the raw data from many third-party payers transferred into their computer for analysis.
If you could see what they knew about every patient you saw and how you operated, you might be a little nervous. Of course, the majority of the profession has nothing to be nervous about. Still, it may be worth your effort to look at you practice and try to envision what such computer data would say about you as a treating doctor.
Health care fraud has gone from an accepted "cost of doing business" to a top priority. In addition to almost every insurance carrier instituting fraud units, many states are creating "fraud funds" to reimburse law enforcement agencies for health care fraud investigation (please see "Northern California Chiropractor Sentenced to Prison for Grand Theft and Insurance Fraud" in the April 24, 1992 issue). The Federal Bureau of Investigation (FBI) has assigned many of their agents to the task of ferreting out health care fraud. Now that there are fewer Soviet spies, the focus is on the health care providers who abuse the system.
On April 12, 1992, the lead story on the popular "60 Minutes" television program was a segment on abuses of the workers' compensation system. Health care fraud is a primary concern to a public that is incredibly overburdened and staggering under the weight of health care costs. The future holds no mercy for those who are shown to abuse the system and contribute to the outrageous costs.
The message is perfectly clear. There will be numerous investigations of DCs, MDs, and DOs, as well as hospitals, laboratories, and rehabilitation centers. The arrests and prosecutions will be ostentatious and broadly publicized by the media, particularly the convictions.
The almost insane cost of health care demands action. The blood bath that is to follow will be intense and without equal. This will be one of the best opportunities the chiropractic profession has to demonstrate our loyalty to our patients and the public.
Or it could be the worst.
DMP Jr., B.S., HCD(hc)
