A few years after I started my own practice, it became clear to me that we would keep growing indefinitely, and that we could no longer operate as a mom-and-pop store. We used to submit our bills by hand. Most people paid cash at the time of the visit, but I noticed that the proportion of patients who expected us to bill the insurance company first was increasing. When Medicare demanded that we submit bills to them first, I knew that we were going to need help.
I talked to a couple of friends who had introduced computers to their offices. They recommended a gentleman who had helped them. He was extremely courteous on the phone. He showed up for an in-person appointment on time. He was immaculately dressed. He spoke like the ultimate professional who had extensive knowledge in his field. He told me that he had a son who was a medical student.
He told me and my staff that he wanted us to see his system at work. We made an appointment to meet him at his office. When we got there, we were greeted by a young woman who seemed to be in a hurry. She led us through dozens of workstations to a smaller room where this gentleman was waiting.
I did not know much about the billing process. I receded to the background while he explained his software to my wife and the office manager. They were impressed with how easy it was going to be to get our money from Medicare and other insurance companies. They felt that we should go ahead with this purchase.
I said that I did not like him.
“Why not? He´s so nice!”
Just because of that. He is too smooth. I get a feeling, when I talk to him, that he is not for real.
“We do need a billing system,” they said.
I had never treated my employees as if they were underlings. In my eyes, all of us were partners. I made medical decisions, and they knew about billing. I hired the man.
He asked for $28,000, most of which money was going to cover the software. He brought several computers to our office. He trained the appropriate personnel. A week later we sent our first electronic bill out. We anxiously waited for our first check from the insurers.
And waited. And waited. All our bills came back with objections from the insurers. We called the gentleman salesman, who came over, several times. He spent a half hour fiddling with the main computer each time. He left, telling us that things would be OK from then on.
They were not.
We still had no money coming in. The $28,000 had depleted most of our bank reserves. I had to borrow money from our bank to meet payroll and pay rent. Two weeks later, there was still no money coming in, and payroll got our bank balance close to zero.
I went back to the bank to ask for another loan. They had noticed that there was no money coming into the account. They did not want to lend me anymore until they saw some deposits.
Phyllis and I were in full panic mode. In retrospect, one of the darkest, probably the darkest, moment of our life together. We were busy and successful. Patients loved us. We worked long hours. We were broke.
The employees, God bless them, said that they could go without one check if this is what had to be done. We made more phone calls to our salesman. He no longer came to the office to try to fix things.
One day we got a letter from him. He told us that he had “borrowed” the software from his business partner. When they had a disagreement about finances, his partner formed his own corporation. Our salesman was just that: a salesman. He knew nothing about how to update the software to make it compatible with the upgrades that the insurance companies made almost weekly. Our software was useless. The office that he had used to demonstrate his software belonged to another business. He had merely rented a room for an hour.
He also told me that he was not able to give me my money back. He had fooled several other doctors. All of them were suing him, and he had no money left. He gave me the phone number of his former partner. He wrote that maybe, for an additional fee, he would agree to update our software.
Which he did, for no additional fee, but I did have to sign a service contract, and I had to agree to keeping him on board for many months. Within two weeks the money began to flow, even the backlogged bills. We could breathe again. We continued to blossom.
White collar crime. Experts disagree on how to define it. Is it defined by who commits it, or is it given its name because no violence is involved? Nobody knows how pervasive it is, because most people who are gypped do not report it (we did not). I have read that experts think that $300 billion a year is a reasonable estimate of what people (and government) lose to scam artists.
I find it hard to understand why society has no trouble spending billions of dollars a year incarcerating harmless drug offenders, but it devotes very few resources to chasing down tax and business frauds. Why are we willing to accept that a billionaire who owns his own plane pays no taxes, yet we go to a lot of trouble putting someone in jail for selling a few joints?
Enforcement of tax and business fraud has decreased under the current administration. Money laundering is rampant among politicians from “friendly” nations. We are losing billions a year because our wealthy legislators do not want to fund the IRS as it should be financed. We do not hire enough federal agents who are specially trained to detect fraud. Is it because these are mostly WHITE criminals?
This will be my last blog on incarceration. I hope that it has made it clear that our prison system is both broken and rotten. If we chased down the rich cheaters, we would have more than enough money to adequately fund social and mental health services. We could decrease our prison population by more than half. We would have safer streets and happier citizens. For decades we have refused to act on the obvious.
Now is the time.
