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The second day the patient will receive additional x-rays of the major area of complaint and 2 film of the adjacent area. The patient is always told that the doctor saw something on the initial film that makes the additional film necessary. Unfortunately, this happens to every patient regardless of the findings on the initial film. When I asked why this was done Hollern stated to me, “I am giving them services the first day so I have to make some money somewhere. It is part of my business system.” This fact was confirmed to me by Dr. Rodney Wisdom when I asked him the same question. Obviously the patients well being is not being considered. They are unbundling and splitting fees. I was instructed to list the proper coding of this situation. My first recommendation was to wait until they had obtained all of the film and then bill the code that reflected that number of film. I was told by Marilyn Sexton that this would not work because in the Hollern system all services were billed the same day. This meant that the two films from day one would have already been submitted. So, day two film had to be billed using a modifier as though the additional film were never anticipated. However they were always “necessary”. I did write coding instructions for proper coding if a doctor does need to take follow-up film (attached). In over 15 years of practice I only found additional film to be necessary in 1 out of every 25-30 patients. I wrote the coding instructions in this manner. However, Hollern instructed his training doctors, students and staff to use this two day x-ray procedure on every patient regardless of how it was written in the training manual or what type of insurance a patient had. Unbundling the codes and taking additional film on day two for every patient resulted in fraudulent billing of all forms of insurance. Hollern felt that if he used this system of x-raying all patients that it was not fraud. However, bait and switch is bait and switch. In addition to bait and switch tactics, the following resulted from Hollern’s business system; unbundling of CPT codes, fraudulent billing practices and unnecessary radiation exposure to the patients. Stapleton has been utilizing this system from the moment he took control of the Shelbyville location. An additional concern here is the taking of x-rays by untrained staff. The therapy CA in each of Hollern’s practices was to take the patients x-rays. I was told at one point during my employment by two of the training doctors that only one of these CAs had been trained and certified by the state. This helped explain the overall poor quality of the films recorded in the Hollern offices. Stapleton hired a therapy CA at Shelbyville named Dianne Green. Just after I left I understand that Ms.Green quit her job in part over being told (by Hollern and Stapleton) the training was to expensive and that she would be shown how to take the necessary film and would function without certification. Page 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20
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