Office is Steering Patients to Another MAPD

Apr 15, 2016

  1. wehotex
    Offline

    wehotex Guru

    Posts:
    1,584
    Likes Received:
    10
    State:
    Texas
    There is a certain clinic that I am aware of who has been steering their patients to an Agent who camps in their office. To date, my Upline gave information of a previous steering to the VP of the Medical Group Administration at this same clinic. Supposedly, this clinic was "under investigation." Today, I received a phone call from one of my existing members who told me that a certain employee in the office wanted me to call her. Haven't done so yet. I changed the PCP with my mb via conference call and insurance carrier. Then, I warned him that that office has a reputation for wanting to switch members over to another agent for a payout, which is "illegal, but they do it anyway." He said that the same person wanted him to call their selling agent (the camper). That proved what I just told the member. I'd like to get CMS involved in this if I can't get satisfaction through the medical group. So sick of it!! What would you do?

    These clinics are notorious for pushing UHC as their preferred carrier, yet they swear up and down that they treat them all the same. Each of the carriers has the same type of Full-Risk contract.
     
    wehotex, Apr 15, 2016
    #1
  2. bluediamond
    Offline

    bluediamond Guru

    Posts:
    2,040
    Likes Received:
    35
    I would get CMS involved.
     
  3. GreenSky
    Offline

    GreenSky Guru

    Posts:
    15,339
    Likes Received:
    452
    State:
    Nevada
    CMS isn't going to give a SHT.

    Rick
     
    GreenSky, Apr 15, 2016
    #3
  4. tins
    Offline

    tins Guru

    Posts:
    3,528
    Likes Received:
    2
    State:
    Missouri
    Not if an agent is complaining. If the client does it and throws around the "fraud" word a few times, they may take a look…maybe the state DOI may be a better place to take it up.
     
    tins, Apr 15, 2016
    #4
  5. wehotex
    Offline

    wehotex Guru

    Posts:
    1,584
    Likes Received:
    10
    State:
    Texas
    I went to the clinic today and confronted the office person very calmly. I questioned why she asked the member to phone another agent and she very calmly said that the patient misunderstood. This might have been possible since the member is def not the sharpest tool in the shed. The girl was far from the stereotypical office bitch, so I somewhat believed her. Anyhow, she now knows that if she's doing it, other agents might be watching.
     
    wehotex, Apr 16, 2016
    #5
Loading...