Medical Billing Forum

General Category => General Questions => Topic started by: Michele on December 28, 2009, 08:53:06 AM

Title: Billing Service Being Hit with Criminal Charges
Post by: Michele on December 28, 2009, 08:53:06 AM
OK, this is a first for me and I'm looking for some input.

I have a friend (no really it's not me!  LOL, she's in a different state) who has had criminal charges brought up against her from a Dr that she terminated.  The Dr was not doing things correctly, the billing service kept advising him, he wasn't cooperating.  The payment arrangement was that she would withdraw her payment from his bank account 7 days after sending him an invoice.  However, she didn't do this because he was always crying the blues about being broke (but his girlfriend went on many trips and had lots of jewelry).  ANYWAY, she sent him a termination letter as stated in her contract. 

She uses a web based system that charges her monthly for each practice/provider.  She advised him that he had until October 31st to access his data before the account would be shut off.  He and his office staff were advised both in writing in verbally that they had until 10/31 to access the data. She never did get paid for her final bill.  She didn't deduct from his account because it was after the date of the termination letter and she followed the contract to a T. 

Now he is claiming he lost $150000 because she has denied him access to his data. 

So the question (FINALLY) is, who owns the data in the web based PM system?  She no longer has access to it either.   

Thanks for the input in advance!

Michele
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Meli on December 28, 2009, 09:24:17 AM
Hi Michele,

The billing service owns the data.  Depending on the web based software your friend is using the information should still be there/available.  She will need to contact her software provider.  Generally when terminating (or no longer servicing) a particular provider they will be marked as inactive in the software but the information for them is not usually deleted as there is always the possibility or servicing that provider again in the future.  If her entire account with the web based software was closed as of October 31st then there should be a time period where she can receive an export of her data in the software but there is usually a fee required by the software company for this information.  There is usually a time period after termination when this data is available but not really sure what happens if its not obtained before that time period expires.  I think it all leads to her contacting the software company to find out how the data is truly handled and how long it is kept as a back up.  Of course if she is contractually within her rights with the doctor she does not have to provide him anything but should still have the details for herself in case of audits and legal issues like the one she's facing now.  Best of luck to her....

Melissa
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Pay_My_Claims on December 28, 2009, 05:30:13 PM
This is why it is so important for Billing Services to provide the practice with 100% information. I am confused as to what she has that he doesn't. If she has all her ducks in a row, she should come out perfectly fine in this case.
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Michele on December 28, 2009, 07:26:44 PM
Well, that's the thing.  He does have all the paper records, and she informed him multiple times (more than 6) that the data would only be available until 10-31.  She also advised him that if he needed access to it longer then there would be a $100 fee.  Not only did he ignore all warnings, but he failed to pay his final bill as well.  The data is there, but there would be a fee to reactivate it, which the provider has been made aware of.  Unfortunately he convinced law enforcement that this is a criminal offense and she has had to report to the police station twice.  Once they were nice, the other, they treated her very poorly!  Anyway, she also had contacted the PM vendor and they confirmed the data is still there, just need the fee to reactivate.  I certainly hope she makes out ok.  She is completely legit, and he's not (I've done work for him as well - although not billing).

Thanks for the responses.

Michele
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Pay_My_Claims on December 28, 2009, 08:18:29 PM
Well, that's the thing.  He does have all the paper records, and she informed him multiple times (more than 6) that the data would only be available until 10-31.  She also advised him that if he needed access to it longer then there would be a $100 fee.  Not only did he ignore all warnings, but he failed to pay his final bill as well.  The data is there, but there would be a fee to reactivate it, which the provider has been made aware of.  Unfortunately he convinced law enforcement that this is a criminal offense and she has had to report to the police station twice.  Once they were nice, the other, they treated her very poorly!  Anyway, she also had contacted the PM vendor and they confirmed the data is still there, just need the fee to reactivate.  I certainly hope she makes out ok.  She is completely legit, and he's not (I've done work for him as well - although not billing).

Thanks for the responses.

Michele


She should contact an attorney at this time. Even being in the right...it only takes one act to destroy your business. It would be well worth the money for her.
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: PMRNC on December 29, 2009, 08:18:10 AM
I think the bigger lesson here is why it's so important to carry insurance and this is a good example of WHY. Anyone can sue anyone for anything. always remember that. Your friend may be right but if she goes into court it won't matter what the doctor bought his girlfriend or how much money he has or doesn't have, bottom line is he will have a case. As for who owns the data it is NOT as cut and dry as you would like to believe. If the billing company was supposed to withdraw funds from the provider's account ( why in hell would have such an arrangement is beyond me) and she didn't than she really did not follow the contract to a "t" and right there you might have a breech. Again this is not as cut/dry in today's legal world. My best advice is for the billing company to get a really good lawyer, right or wrong if the provider brings suit, they could very well win and even if it's settled before charges are brought against anyone, it will cost quite a hefty fee for a defense.
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Michele on December 29, 2009, 09:29:46 AM
I told her the same thing (about getting a lawyer), and I think she already has.  The provider is not suing her which is what is weird (probably doesn't have money to retain an attorney), but he is bringing criminal charges.  Of course the police know nothing about how insurance/billing services etc work.  I'm not sure if she has insurance but it certainly is the perfect example of why it's so important!

Welcome Back Linda!  We missed you.  :)

Michele
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Pay_My_Claims on December 29, 2009, 11:17:23 AM
yup, i thought she just fell out with us or something....(welcome back)
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: PMRNC on December 29, 2009, 11:45:35 AM
I have been awol as I'm very busy this time of the year..some days I don't know which hat to put on.. LOL

When you said they are bringing criminal charges against them.. have they done so already? what step is it in? Does DA have complaint, if so they will decide if there is enough evidence to proceed with a case, I would think at that stage there is a major reason to worry.
 Do you know exactly what charges he's filing?
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Pay_My_Claims on December 29, 2009, 03:45:17 PM
u are allowed 1 AWOL per 10 years!!
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Michele on December 29, 2009, 08:48:53 PM
Originally the police contacted her and were very nice, but asked her to bring in copies of a bunch of the paperwork she had.  They said he was claiming criminal charges.  Then they called her a second time and were not so nice.  They said that he is claiming that he lost $150000 in patient payments due to her preventing him from accessing his data.  The funny thing is, $1500000 is the exact amount required for it to be considered criminal.  He just made that number up.  He would not charge his patients anything, and that is one of the main reasons she terminated him.  She went in, trained his staff on collecting copays, etc, and they would do it for about 1 day, then stop.  He is out of network with most companies, which added to the problems.  She couldn't do adequate patient billing because his staff didn't provide her with the info she needed.  She terminated the contract in writing advising him how long he would be able to access his data.  She also advised him verbally multiple times and explained he could have longer if he paid the addt fee from the software company. 

When the police called back and were not so nice, she asked them why they were now threatening her when she had cooperated fully and had provided all documentation backing up her side.  They backed right down.  The third time she spoke witht hem they indicated that they called the software company and verified that the data was there but was deactivated due to termination, just as she had explained.  It looks like it may not go any further as he has absolutely no documentation, and she has all her i's dotted and t's crossed.  Also, the software company supported her story. 

The reason she didn't withdraw the final bill (I agree, I don't know why she has that agreement!  Her husband is an accountant so maybe that's why.) was because she could not withdraw until 7 days after the invoice, and the final invoice was sent on the last date before termination.  She felt that since it was after her services were terminated, that voided her right to access his account.

WHEWWWW, that's alot of typing.

She's a great person who tries to do all things correct.  She appreciates the input.  Does anyone know who legally owns the data that is input into the web based PM system?  To me, that is the question.  She did provide him with all reports, and he had all original paperwork that she was giving to do the billing.  So she didn't actually withhold anything from him. 

Insurance doesn't help here does it?

Michele
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: kwardbilling on January 14, 2010, 07:46:28 PM
Did she have anything in her contract about the reports or paperwork being returned to him?  This is a scary story......I hate hearing stuff like this,
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Michele on January 14, 2010, 07:50:32 PM
I'm not sure.  I know she had a good contract, but I don't know the details.  Very scary.

Michele
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: QueenAlicia on January 29, 2010, 12:44:17 AM
I am glad you shared this story.  As a start up I am trying to get all of my ducks in a row and this has really made me see that I need to move at a slow steady pace and do everything correctly.
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: amelero on October 11, 2010, 09:15:33 PM
She can get the Dr in trouble for waiving co-pays.

Title: Re: Billing Service Being Hit with Criminal Charges
Post by: PMRNC on October 12, 2010, 06:19:26 AM
Quote
She can get the Dr in trouble for waiving co-pays.

The biller is in this WITH the doctor. If you are billing for any provider that is involved in any type of fraud/abuse, you are JUST as libel.
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: DMK on October 12, 2010, 10:23:05 AM
Which is why you choose your customers carefully and know the laws so you can update the customers!
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: PMRNC on October 12, 2010, 01:02:49 PM
Quote
Which is why you choose your customers carefully and know the laws so you can update the customers!

True, but secondary to carrying good E/O insurance!
Title: Re: Billing Service Being Hit with Criminal Charges
Post by: Advent2010 on October 20, 2010, 07:24:02 PM
In answer to your basic question about who owns the data in a web based software, your answer lies in who pays for the software?  If she pays for it and allows him access to it, she owns it.  In reading through the history of the issue, it sounds to me that she does own it.  I previously worked with two software companies that had web based software and we were always told that the purchaser owns the data.  She did the right thing by keeping the doc informed about the cut off date in writing and verbally as this will serve as her proof.  If the doc is too stingy to pay the additional fees, he should have requested a data export and had the info placed on a disc, but he didn't.  She is in the right.