Many many years ago, in my yoot, I worked for a peer review organization which did quality of care and cost analysis for Medicaid and Medicare. It was not for profit and came to a screeching hault during one of the constant funding problems the state had. I was a quality of care programmer writing all of the reports and indexed file entry programs to track quality of care issues from the review process. There were a fleet of nurses in the field looking over samples of patient folders looking for things that seemed odd. Those folders would find their way to the home office for physician review. Issues went from rank-1 (documentation) all the way up to rank-4 (gross and flagrant) where there was a high probability we would recommend the revoking of a license.

Occasionally we would get specific requests from Medicaid and Medicare to review billings that were out of the ordinary. Not that they tried to over charge the agency, but the same medical license was seeing patients in two different states on the same day.

There is one case I will never forget. Just such a request came in asking for a review of charts and invoices filed by a license number which appeared to be practicing in IL and … some extremely backwoods remote area of either Mississippi or Kentucky. It had been going on for about a year and they wanted a detailed investigation since our cursory transposition of digits check didn’t turn anything up.

I have never felt so bad for someone or seen such a miscarraige of justice. It turned out the doctor had been working in IL and shared office space with another doctor (whose license number he was now using). They did not share filing systems or clerical help. This particular doctor had hired clerical help that apparently had no concept of the alphabet or patient folders. There had never been a single quality of care complaint logged against him, but a year prior some random inspection of patient records found now two folders in the office actually contained records for only one patient. I don’t remember all of the details, just that his license got pulled as a result.

Usually, when a doctor gets a license pulled but keeps on practicing medicine it is greed or ego (usually both). Not this dude. He picked up and left an upscale suburb for a place that shows up on those “could it really exist in America” news clips you see during sweeps week. This time he apparently hired a clerk that could handle all of the filing and billing. Once again, not one single medical quality of care issue turned up. Had the billing not triggered a fraud sensor he would probably still be practicing today. He was the only doctor they had and pretty much everybody was either on some kind of government healthcare or seeking charity care.

I think of this story when the healthcare debate comes up. A doctor who had sh*tty office help got his license revoked. He tried to do penance by providing great care in a place which had no doctor. He still got prosecuted.

A 16yo kid, having no medical schooling what-so-ever, can sit at a desk in an office a deny you life saving emergency treatment. Neither they, nor the company that hired them can ever be sent to prison for practicing medicine without a license. On a basis of nothing more than quarterly profits, they have their own little built in Euthanasia board, but Wall Street calls them the Board of Directors.