Back to All

REP 12 - “It’s fine – they’re my friend!” Caught in the net of unethical practice

Anonymous

I was a new grad when I started work at a private practice clinic that treated mostly motor vehicle accident (MVA) patients. At the time, I had only seen a handful of MVA patients, and was still just working on my skills at completing and submitting MVA treatment forms to insurance companies.

I was enthusiastic to learn more about this unique population and how I could help these patients who often coped with chronic pain and psychosocial concerns.

As I settled in and began preparing MVA treatment plans, I noticed something strange:  my boss – a chiropractor – would go online and modify my plans. He would then submit them on my behalf under my registration number. For example, even if I thought that a patient needed 10 physiotherapy visits, I would notice that it was increased and submitted as 20 visits. 

 

At first, I felt confused. This chiropractor worked at a different clinic location: how could they provide input on what the patient needed? However, I realized that these “updates” were happening to the other physiotherapists in the clinic; they were also new grads.

The realization of what was happening was both exasperating and exhausting. The thought of speaking up for what was right left us feeling worried that we might lose our jobs. 

After about a week of reflection, I decided to do it. I spoke up to my boss and stated  “You cannot submit MVA treatment plans under my registration number – only I can, as the physiotherapist.” My boss acknowledged my statement.

But then it happened again. My boss modified my patient plans and then submitted them under my registration number.

I spoke up again, in person. I spoke up in writing on my staff email, and it eventually stopped – for my registration number. My boss continued to modify patient plans and submit them under any colleagues’ registration numbers who were not as firm as I had been. 

This uncomfortable experience left me wondering, “Why were these types of issues not discussed thoroughly at university?” 

In another instance, I noticed that a private practice patient had been billed to the insurance company for the treatment of “two areas.” I asked the front staff why this had happened, and they replied that our boss had told them to. The workflow of the clinic did not involve physiotherapists signing off for extended health care forms – which put billing numbers at risk. 

 

When I confronted my boss, he said “It’s fine – they’re my friend!” 

I also discovered that double-billing was happening for family members, as well. This knowledge made me feel like I had the wind knocked out of me. 

This was a clearly unethical practice, so I said “I’m not comfortable if the insurance company is billed for two areas if I’m treating them for one injury”. To this, my boss replied “Can’t you just treat them for another area?” 

I declared that unless the patient presented another concern, I would have to do a full assessment to determine if another area warranted treatment.  

The situation left me feeling personally manipulated in addition to the blatant and fraudulent manipulation of my billing number.

At a time that we should have had growing enthusiasm for the wonderful profession that is physiotherapy, my new grad colleagues and I felt deflated. On more than one occasion, I called the College of Physiotherapists of Ontario (CPO)’s Practice Advisor to discuss my concerns. 

Despite support from the Practice Advisor and other like-minded colleagues, I recall crying in my car on the way to work a few times. I was disappointed and overwhelmed by the multiple ethical dilemmas I was facing. 

I ultimately chose to leave this facility. Despite speaking up for what I felt was right, I no longer trusted that my billing number would be used appropriately. I felt taken advantage of, which took a toll on me both professionally and personally. 

When I shared some of my experiences with close physiotherapist friends, they were simply disgusted, and relieved that I left the clinic.

 

About a year after I left this clinic, I reached out to Health Claims for Auto Insurance (an electronic system for transmitting auto insurance claim forms between insurers and health care facilities in Ontario) to ensure that my billing number was not being used inappropriately. Thankfully, an “end date” for my billing number had been entered by the facility. 

As stressful as this experience was, I wouldn’t change it. Going through that situation made me stronger in my ethical reflection and decision-making skills. 

As a profession, we have to be able to do what is right – our individual and collective reputations depend on it.

 

Over to you.

  1. Have you ever experienced a situation where your registration number was input by someone other than yourself?
  2. What advice can you share with new grads who might experience a similar situation?

 

 

#30REPS 2017 is brought to you by:

 

 

Read more #30REPS

 

Comments

I used to work in a clinic with similar unethical values. The managers would reprimand us if we were not using up all of the allowed MVA visits, even if we were able to get the client back to good health faster than the maximum number of visits allowed. We were told that we were not giving "quality" treatment if we weren't maximizing the visits used. Back then I was a new grad, but I know better now. That clinic was basically trying to maximize their own earnings fraudulently.

Thank you for sharing your experiences.  What you are describing does not sound like patient centered care. It sounds like what many of the regulators described as the point when ethical concerns arise- when you place your own needs (or your employer's needs) ahead of the needs of your clients. Keep your eye out for the #QualityPT toolkit coming Fall 2017.

What resources might have been helpful to you as a new grad?

@CPA_Melissa

At the clinic for which I work, we hand sign all our reports and they are faxed in to the payer and physician, whether the payer is an auto insurance or WCB.  If a situation arises when another physiotherapist must sign (which does on occasion, such as during vacations/illness), then it is signed with their own name with a "for [the regular treating physiotherapist]".

When we have gained a new population to serve, we have had our reports proofread by another who has more experience with that population... but then they are returned to us for changes.  Thankfully, none of the changes suggested were unethical and all improved the clarity of the report.

 

Kudos to your team for having a process in place.

What processes can we put in place to prevent tampering of electronic submissions to 3rd party payers?

@CPA_Chantal

I am shocked and saddened by this story. Keep listening to your good sense of what is ethical and professional. I am happy to report that I have been a practicing registered physiotherapist for 30 years and fraudulant or unethical activity has never been tolerated at any of my workplaces. I think the vast majority of physiotherapists are ethical and put their patients first. When I first graduated, I was warned that it was safer to work in a clinic that is owned and operated by registered physiotherapist - perhaps this is still good advice.

 

Great point- it is always important to not jump to conclusions and to clarify the intention in many interactions.  The spoken word is such a small portion of total communication (7% to be exact).

There is a difference in mentoring a young professional and undermining their professional judgement.  As professionals, we need to be aware of how our words and actions can be perceived.

@CPA_Melissa

So shocked to read this. I've been attending regular physiotherapy at the Brampton office (http://bramptonphysio.ca/)  of LifeClinic and nothing like this has ever happened to me.

 

Leave a Reply

Your email address will not be published. Required fields are marked *