Home > Fraud Awareness, SID Information > Hypocrisy rather than Hippocrates: Providers who harm patients and society

Hypocrisy rather than Hippocrates: Providers who harm patients and society

Wikipedia explains The Hippocratic Oath is an oath “historically taken by doctors and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students.” In the original classic version of the oath, translated into English, the individual established a covenant with patients and society by promising to meet several commitments, including:

“I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.”

Most providers – whether they are physicians, surgeons, chiropractors, pharmacists, or medical professionals in hospitals or urgent care facilities – honor the oath. Further, even those who do not formally take the oath – such as durable medical equipment vendors, members of third-party administrators or managed care organizations – adopt its precepts and meet its intent.

Sadly, however, other providers violate the oath, acting with hypocrisy. They deceive us and commit crimes. They harm claimants, sometimes fatally. They harm insurers, including the BWC State Fund, by billing for services not rendered, not needed, or furnished by an unlicensed provider, manipulating procedure codes to bill for a more expensive treatment than provided, prescribing unnecessary drugs, operating pill mills and injury mills, or drug trafficking. Subsequently, employers are harmed when they must pay additional premiums to cover undetected fraudulent provider costs and manage an impaired work force. Employees are harmed by reduced wages, job loss and workplaces made unsafe by impaired co-workers. Indeed, all of society suffers.

We recognize the impact of provider fraud upon Ohio. In 1994, our department created the Health Care Provider Team to exclusively investigate this type of fraud. In 2005, we expanded the team with dedicated analysts and agents located statewide. During the last two years, the Health Care Provider Team made 36 criminal referrals for prosecution to state, county and local prosecutors. During last year alone, their work resulted in the identification of over $8.2 million in savings to BWC’s State Fund.

During the month of October, we will discuss several of the above provider fraud schemes, introduce other BWC departments tasked with regulating providers and describe strategies that our department uses to detect provider fraud. Look for our next fraud awareness article that will discuss providers who bill for non-rendered or unnecessary services, two of our more common provider fraud complaints.

Meanwhile, be sure to read more about our fraud investigative performance results in the SID FY 2011 Annual Report.

If you suspect that a subject is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

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  1. October 11, 2013 at 11:03 am

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