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